Claudia Steurer-Stey1, Maja Storch2, Susanne Benz2, Barbara Hobi2, Barbara Steffen-Bürgi3, Johann Steurer4, Milo A Puhan4. 1. 1Department of General Practice and Health Services Research,University of Zurich,Zurich,Switzerland. 2. 2ZRM Research,Unit of Continuing Education,Department of psychology,University of Zurich,Zurich,Switzerland. 3. 3Centers for Development and Research in Nursing,Department of education and research,University Hospital of Zurich,Zurich,Switzerland. 4. 4Horten Centre for patient-oriented research and knowledge transfer,Department of Internal Medicine,University of Zurich,Zurich,Switzerland.
Abstract
BACKGROUND: Adherence to self-management in asthma is poor. AIM: To investigate the effect of disease-unspecific motivational training on self-management adherence in addition to asthma-specific patient education. METHODS: We randomized patients with partly controlled asthma to asthma education, with or without the Zurich Resource Model (ZRM) training. Main elements of the ZRM training are development of action-oriented personal goals and activation of resources to achieve and practice them in daily life. The primary outcome was adherence to self-monitoring and to a written personal action plan during three months. Secondary outcomes included patient-reported self-efficacy. RESULTS: As control patients (n=30) were younger, mostly male and had better asthma control compared with the intervention group (n=30), we adjusted the analyses for these imbalances. Both groups showed excellent adherence to self-monitoring over three months [27 patients (90.0%) in intervention and 25 patients (83.3%) in control group, adjusted odds ratio: 1.28 (0.24-6.78), P=0.78)]. Patients in the ZRM group tended to adjust their medication more often [median 36% days with action (IQR 11-62%)] than control patients [9% (0-43), P=0.18]. In both groups, actions were rarely in accordance with the action plan [median 20% of actions appropriate (IQR 0-37) in intervention and 11% (IQR 0-56) in control group, P=0.92]. After three months, self-efficacy was significantly better with ZRM (adjusted difference on self-efficacy scale 2.31, 95% CI 0.31-4.31, P=0.02). CONCLUSION:Unspecific self-management training had no short-term effect on self-management adherence in asthma patients. Self-efficacy improved, but it is uncertain whether this translates into better long-term outcomes.
RCT Entities:
BACKGROUND: Adherence to self-management in asthma is poor. AIM: To investigate the effect of disease-unspecific motivational training on self-management adherence in addition to asthma-specific patient education. METHODS: We randomized patients with partly controlled asthma to asthma education, with or without the Zurich Resource Model (ZRM) training. Main elements of the ZRM training are development of action-oriented personal goals and activation of resources to achieve and practice them in daily life. The primary outcome was adherence to self-monitoring and to a written personal action plan during three months. Secondary outcomes included patient-reported self-efficacy. RESULTS: As control patients (n=30) were younger, mostly male and had better asthma control compared with the intervention group (n=30), we adjusted the analyses for these imbalances. Both groups showed excellent adherence to self-monitoring over three months [27 patients (90.0%) in intervention and 25 patients (83.3%) in control group, adjusted odds ratio: 1.28 (0.24-6.78), P=0.78)]. Patients in the ZRM group tended to adjust their medication more often [median 36% days with action (IQR 11-62%)] than control patients [9% (0-43), P=0.18]. In both groups, actions were rarely in accordance with the action plan [median 20% of actions appropriate (IQR 0-37) in intervention and 11% (IQR 0-56) in control group, P=0.92]. After three months, self-efficacy was significantly better with ZRM (adjusted difference on self-efficacy scale 2.31, 95% CI 0.31-4.31, P=0.02). CONCLUSION: Unspecific self-management training had no short-term effect on self-management adherence in asthma patients. Self-efficacy improved, but it is uncertain whether this translates into better long-term outcomes.
Authors: Stephanie Anna Lenzen; Ramon Daniëls; Marloes Amantia van Bokhoven; Trudy van der Weijden; Anna Beurskens Journal: PLoS One Date: 2017-11-27 Impact factor: 3.240
Authors: Tiny Jaarsma; Heleen Westland; Ercole Vellone; Kenneth E Freedland; Carin Schröder; Jaap C A Trappenburg; Anna Strömberg; Barbara Riegel Journal: Int J Environ Res Public Health Date: 2020-12-17 Impact factor: 3.390