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Effect of self regulatory education on women with asthma- 2003(2)

Effect of self regulatory education on women with asthma- 2003(2)



Effect of self regulatory education on women with asthma- 2003(2)

Effect of self regulatory education on women with asthma- 2003(2)

Noreen M. Clark
Center for Managing Chronic Disease
University of Michigan



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  • About 50% of the participants are 41 to 60 years of age. One fourth are older than 60 years of age and other one fourth are younger than 40 years old. .
  • Eleven percent of the women have less than 20,000 annually household income and 11% of the women refused to report. Eighteen % between 20,000 to 40,000. About 35% of the women reported in a range of 40,000 to 60,000 annual household income.
  • Twenty-six% of the participants are high school graduates, 21% two-year college, 30% 4-year year college, and 21% post graduate.
  • About 16% of the participants are minorities
  • Classified by NAEPP criteria, USA, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997

Effect of self regulatory education on women with asthma- 2003(2) Effect of self regulatory education on women with asthma- 2003(2) Presentation Transcript

  • Effect of Self-Regulatory Education on Women with Asthma July 12, 2003
  • Outlines
    • The research project
    • The intervention program
    • Baseline findings
  • Investigators
  • Research Team PI (Co-PI & Co-investigators) Oversees all aspects of the study Project director-secretary Daily operation Data collection team 5-6 graduate students Recruiting & interview Intervention team 2-3 health educators Deliver program Data analyst Manager/Analyst Database / analysis
  • Background - Prevalence
    • Five million women are currently diagnosed with asthma (Crespo, 1997)
    • Asthma prevalence rate for women increased 82% compared to 29% for men (1982-1992, CDC)
    • Asthma mortality rate increased 59% for women compared to 34% for men (1982-1992, CDC)
  • Background – Morbidity & Hospitalization
    • Hospital admission for asthma: Women 2 times more than men. (Skobeloff, 1996)
    • More symptoms and worse quality of life reported by female asthma patients compared to male patients. (Osborn, 1998)
  • Menstrual-Linked Asthma
    • 30-40% of women with asthma report symptoms worsening prior to or during menses. Significantly reduced Peak Flow Rates, more medication and health care use were found during this period of menstrual cycle. (Agarwal, 1997; Eliasson, 1986)
    • Disease is more severe in women with menstrual-linked asthma.
    • Use of oral contraceptive medication may reduce symptom variability in women with menstrual-linked asthma.(Tan, 1997)
  • Factors Related to Women’s Traditional Tasks in Household
    • Cooking-related irritants and triggers include gas, wood smoke, cooking oils, food preservatives, monosodium glutamate, coloring agents.
    • Cleaning-related indoor allergens include house dust, domestic house-dust mites, fungi, molds, yeasts, sprays, cleaning products, and scented products.
  • The research project Purpose
    • To evaluate an innovative education program based on self-regulation theory designed to address the unique needs of adult female patients with asthma.
  • Specific Hypotheses
    • Decreased gender-related asthma management problems
    • Decreased symptoms
    • Reduced health care use
    • Reduced work absence
    • Improved quality of life
  • Study Design
    • A randomized controlled design utilizing an intervention group and a control group.
  • Recruitment criteria
    • 18 years of age or older
    • A diagnosis of asthma
    • A patient in one of the clinics at University of Michigan Health System
  • IRBMED Approved Recruitment Procedures
    • A list of female patients diagnosed with asthma is provide by the UM Health System Data Warehouse
    • An individual Invitation letter signed by investigators and personal physician is mailed to the potential participant
    • A phone call follows
    • Consent forms are sent for signatures
  • Data collection
    • Baseline
    • Follow-up I: 12 months subsequent to baseline (approximately 6 months subsequent to program completion)
    • Follow-up II: 12 months subsequent to there after.
    Three time points :
  • Randomization
    • After baseline data collection, participants are randomly assigned to either the intervention or the control group. Women in the intervention group receive the “Women Breathe Free” telephone counseling program. Women in the control group will receive the program after it is evidenced to be effective and requested by the woman .
  • Components of the intervention
    • Theoretical Framework-Social cognitive theory (Bandura, 1986), and the principles of self-regulation (Clark & Zimmerman, 1990, Clark, 1992) applied
    • Gender-related management problems addressed
    • Peak flow meter and diary used
    • Telephone counseling sessions delivered
  • Asthma Education Kit
    • Workbook
    • Peak Flow Meter
    • PFM Video
    • Diary
  • Our Health Educators
  • What the Health Educators Do
    • Introduce a problem solving process.
    • Guide through a period of self-observation using PFM & Diary.
    • Encourage to discuss questions and observations with physicians to enhance the patient-physician partnership in asthma management.
  • Self-regulatory problem solving steps First step: select a problem
    • I have a problem with my diagnosis of asthma: Do I really have asthma?
    • I feel chest tightness and/or may wheeze whenever I cook, vacuum, or dust.
    • My asthma symptoms get worse when I have premenstrual syndrome.
    • Smoke may trigger my symptoms, and I live with someone who smokes. I’m afraid to tell them because I don’t want to hurt their feelings.
  • Second step:
    • Coach the participant to use diary and peak flow meter as observational tools to track related factors. The participant logs peak flow readings, hormonal cycles, symptoms, triggers, other medical conditions, medication use, tasks, activities & events every day for 4-6 weeks.
  • Women Breathe Free Program
  • Third step:
    • Identifying self-management asthma goal (short and long term goals)
    • Long-term goal: to clean the house without wheezing.
    • Short term goal: to vacuum the house without symptoms
    Examples of Goals
  • Fourth step: Developing my plan
    • Steps to reaching my short-term goal are:
    • 1. Buy masks & dust proof vacuum bags.
    • 2. Wear mask every time I vacuum.
    • 3. Have someone vacuum for me.
    • Developing a plan for reaching the goal (lists of barriers and strategies to reach the goal)
  • Developing my plan: Instruct & trust other people can do a good job Feel someone may not be able to do a good job Hang mask on vacuum cleaner handle Forget to wear mask Ask my asthma coach or look at information in workbook under supplies Did not know where to purchase masks & vacuum cleaner bags Strategies Barriers
  • Other self-regulatory steps
    • Exploring a reward
    • Developing a health-related contract
  • Preliminary Evaluation
    • Among a total of 166 program participants, 80% (n=131) completed required 4 diaries, 83% (n=109) completed 8 or more diaries, 87% (n=113) completion with 4 categories,
    • 94% completion of peak flow entry.
    • I was a reluctant participant with mild asthma but found the program helpful in identifying when to use medication. I am now more likely to use my inhaler than I might have been without the program.
  • Baseline Findings
  • Sample demographics (n=439) Age
  • Sample demographics
    • Annual Household Income
  • Sample demographics Education Level
  • Sample demographics
    • Race/Ethnicity
  • Asthma severity Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, NHLBI, NIH, 1997 14.58 Severe persistent 18.45 Moderate persistent 14.35 Mild persistent 52.62 Mild intermittent Percent of Women
  • Co-Morbidities Reported
    • Reflux: 72%
    • Over weight (BMI=26-30): 28%,
    • Obese (BMI 31-35): 30%
    • Over obese (BMI > 35): 9%
  • Co-Morbidities Reported
    • Urinary incontinence: 54%
    • Migraines: 34%
  • Health care utilization during the past 12 months
    • One fourth of the women had at least one ED visit.
    • 8% were hospitalized
    • 35% had one or more unscheduled urgent visit to a doctor’s office.
  • Peak Flow Meter Usage
    • Almost 80% of the women owned a peak flow meter.
    • Less than 7% of the women used it every day.
    • 30% used their peak flow meter only when they felt an asthma attack was coming on.
  • Factors Associated with Persistent Disease
    • Low annual household income, a lower level of education, and not working for pay were associated with persistent asthma, whereas, age, marital status, and ethnicity were not.
    • Women with persistent asthma were more likely to have high BMI, maintain a low level of exercise, have lower self-esteem, had more social support compared to women with intermittent disease.
  • Hormone Related Findings
    • 54% women currently menstruate. Among those:
    • 15% noticed symptoms worsening during the week prior to the period.
    • Over half of the women reported PMS symptoms. The more severe the asthma symptoms, the more severe the PMS symptoms (r=0.364, p<.0001)
    • 30% women reported they were bothered by symptoms of asthma during sexual activity. The more severe the asthma symptoms, the more bothersome during sexual activity (r=0.361, p<.0001)
  • Hormonal factors and health care utilization Menstruation and Asthma Health Care Utilization
  • Urinary incontinence was significantly associated with
    • older age, not working for pay, ever been pregnant, history of smoking, and a higher body mass index.
    • more days of daytime and nighttime symptoms and more hospitalizations and clinic visits.
    • lower self-esteem, social support, and overall quality of life.
  • Overweight was significantly associated with:
    • Older age (p=.05), lower level of education (p=.0001), and household income (p=.002), being unmarried (p=.02), and African American (p=.04);
    • More days of daytime (0=.06) and nighttime symptoms (p=0.08), more hospitalization (p=.0001), ED visit (p=.0029), urgent office visits (p=.008), scheduled office visits (p=.03), and visits to follow-up an asthma attack (p=.009);
    • Urinary incontinence (p=.0001), migraine headache (p=.03), and reflux (p=.02);
    • Lower level of quality of life (p.0002) and self-esteem (p=.001)
  • Limitations
    • This study sample includes a number of women with high levels of education and income.
    • The findings reported here are from preliminary analysis.
  • Thank You!