Testing an intervention to promote children's adherence to asthma self-management

Purpose: To test the hypothesis that compared with the control group, 7 through 11-year-old children with persistent asthma who received asthma education plus a contingency management behavioral protocol would show higher adherence to peak expiratory flow (PEF) monitoring for asthma self-management and would report fewer asthma episodes. Design and Methods: A randomized, controlled trial was conducted with 77 children with persistent asthma in a southeastern U.S. state. Both the intervention and control groups received instruction on PEF monitoring. Only the intervention group received asthma education plus contingency management, based on cognitive social learning theory, including self-monitoring, a contingency contract, tailoring, cueing, and reinforcement. At-home adherence to daily PEF monitoring during the 16-week study was assessed with the AccuTrax Personal Diary Spirometer, a computerized hand-held meter. Adherence was measured as a percentage of prescribed daily PEF uses at Weeks 4 (baseline), 8 (postintervention), and 16 (maintenance). Results: At the end of the baseline period, the groups did not differ in adherence to daily PEF monitoring nor at Week 8. At Week 16, the intervention group's adherence for daily electronically monitored PEF was higher than that of the control group. Children in either group who were >= 80% adherent to at least once-daily PEF monitoring during the last week of the maintenance period (weeks 8 to 16) were less likely to have an asthma episode during this period compared with those who were less adherent. Conclusions: The intervention to teach children to adhere to the recommended regimen for managing their asthma at home was effective.