Pictorial versus written asthma action plans for youth: initial impact on regimen knowledge, medication adherence, symptom control, and family satisfaction

Abstract

Objective

Asthma action plans (AAP) are recommended to guide asthma management. Written AAPs (WAAPs) are under-utilized and can be difficult to understand. Our study designed and tested a simplified pictorial AAP (PAAP). We hypothesized that better outcomes would be obtained for youth with the PAAP.

Methods

One hundred and sixty-nine (169) youth (aged 8–17; AAP-naïve) were screened for this pilot, 2-arm randomized controlled trial. Feasibility, usability and preliminary efficacy of PAAP compared to a WAAP, for improving outcomes (inhaled corticosteroid (ICS) adherence, symptom control, AAP knowledge, AAP satisfaction) were assessed quantitatively. Youth received an AAP from their physician after completing baseline measures and completed measures at three additional time points (1-, 3-, and 6-month).

Results

Forty-five youth were recruited (PAAP = 22; WAAP = 23). Youth AAP knowledge was higher for the PAAP group compared to the WAAP group (p = .017). ICS adherence did not differ between groups, over time, or based on prescribed dosing; however, for WAAP participants, adherence was lower with a higher daily prescription (4 puffs) relative to a lower dose (p = .006). Symptom control improved with both AAPs, but the change was not statistically significant. Lung function did not change significantly by AAP type or time, and literacy variables were not related significantly to outcomes. Youth satisfaction with AAP improved significantly for the PAAP group compared to the WAAP group (p = .03).

Conclusions

Higher AAP knowledge and satisfaction among youth in the PAAP group suggests that structured education from a physician using a PAAP is beneficial. Intervention and study design insights gained will guide future research.

Keywords:

• Education
• management/control
• pediatrics
• treatment
• prevention

Acknowledgements

The authors thank the Physician Advisory Panels (Maple Landvoigt, MD; Mary Beth Hogan, MD; Carolyn Kercsmar, MD; Shalini Forbis, MD, MPH; Patricia Dubin, MD; David Thomas MD, PhD; Janani Narumanchi, MD; Harold J. Farber, MD; Laura Caffey, MD; Matthew A. Rank, MD; Chitra Dinakar, MD; Douglas Bush, MD) and the staff in the recruiting clinics (Holly Ledonne, Bridget McDonnell, Kyria Gaydosh, and Yvette Tomago) for their invaluable contributions to the conceptualization and implementation of this project. We also are grateful for the consistent support and guidance with the development of our pictorial asthma action plan software from Carolyn Caruso at BeHealth, LLC. We extend our sincere appreciation to the youths and families who took part in this study.

Declaration of interests

The authors report no conflicts of interest relevant to this article to disclose. The authors alone are responsible for the content and writing of this article.

Author notes

Lisa Hynes is now at Croí Heart & Stroke Center, Galway, Ireland; Viral Kothari is now at Pediatric Sleep Specialists, Colorado Springs.

Additional information

Funding

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under [R40 MC28320]. The information, content and/or conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.