H Shonna Yin1, Ruchi S Gupta2, Suzy Tomopoulos3, Alan L Mendelsohn4, Maureen Egan5, Linda van Schaick3, Michael S Wolf6, Dayana C Sanchez3, Christopher Warren7, Karen Encalada3, Benard P Dreyer3. 1. Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York; yinh02@med.nyu.edu. 2. Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and. 3. Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; 4. Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York; 5. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York. 6. Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 7. Center for Community Health, and.
Abstract
BACKGROUND AND OBJECTIVES: The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS: Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES: medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS:119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS: Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
RCT Entities:
BACKGROUND AND OBJECTIVES: The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS: Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES: medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS: 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS: Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
Authors: Alexander F Glick; Jonathan S Farkas; Joseph Nicholson; Benard P Dreyer; Melissa Fears; Christopher Bandera; Tanya Stolper; Nicole Gerber; H Shonna Yin Journal: Pediatrics Date: 2017-08 Impact factor: 7.124
Authors: Bhupendrasinh F Chauhan; Maya M Jeyaraman; Amrinder Singh Mann; Justin Lys; Ahmed M Abou-Setta; Ryan Zarychanski; Francine M Ducharme Journal: Cochrane Database Syst Rev Date: 2017-03-16
Authors: Janina Curbach; Jonas Lander; Marie Luise Dierks; Eva-Maria Grepmeier; Julia von Sommoggy Journal: BMJ Open Date: 2021-11-16 Impact factor: 2.692