Improving youth question-asking and provider education during pediatric asthma visits

https://doi.org/10.1016/j.pec.2018.01.013Get rights and content

Highlights

  • Youth in question prompt list with video intervention more likely to ask questions.

  • Providers more likely to educate youth who watched video and used prompt list.

  • Providers were more likely to educate youth who asked one or more questions.

Abstract

Objective

We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits.

Methods

English or Spanish-speaking youth ages 11–17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the video on an iPad and then completed an asthma question prompt list before their visits. Generalized estimating equations were used to analyze the data.

Results

Forty providers and 359 patients participated. Intervention group youth were significantly more likely to ask one or more questions about medications, triggers, and environmental control than usual care youth. Providers were significantly more likely to educate intervention group youth about rescue medications, triggers, and environmental control. Intervention group caregivers were not significantly more likely to ask questions.

Conclusion

The intervention increased youth question-asking and provider education about medications, triggers, and environmental control. The intervention did not impact caregiver question-asking.

Practice implications

Providers/practices should consider having youth complete question prompt lists and watch the video with their parents before visits to increase youth question-asking during visits.

Introduction

Research has shown that children and adolescents are not actively involved during their medical visits [[1], [2]]. Traditionally, the adolescent’s contribution during medical visits has been limited to approximately 10% of the visit and the communication is dominated by the physician and parent [[1], [2]]. Parents often restrict the adolescent’s participation and want to dominate the medical visit [1]. However, actively involving youth during visits could improve their medication knowledge and their overall physical functioning [[3], [4]]. Street and colleagues [[5], [6]] posit that patient-provider communication can improve a clinical outcome directly as well as indirectly via increased patient engagement in self-care skills.

In our prior work that examined provider-patient communication during pediatric asthma visits, we found that only 13% of adolescents asked questions about asthma management and that the majority of questions that adolescents asked were about asthma medications [7]. We also found that 78% of adolescents expressed one or more asthma medication problems yet only 11% asked a question about their medications during their medical visits [[8], [9], [10], [11], [12]]. One potential way to improve youth involvement during visits is through the use of “question prompt lists”. Cancer researchers have found that giving cancer patients “question prompt lists” before their visits increased the number of questions that patients asked their doctors, improved patient recall of information, and prompted doctors to give patients more information [[13], [14], [15], [16]]. A “question prompt list” is a list of common questions a patient might want to ask their doctor about their condition and its treatment. This paper reports on the initial results of a pragmatic randomized, controlled trial (RCT) testing the effectiveness of an asthma question prompt list with short video intervention compared to usual care. We examine whether youth in the intervention group were more likely to ask one or more questions about medications, triggers, and environmental control than youth in the usual care group. We also investigate whether providers were more likely to educate youth in the intervention group about control medications, rescue medications, triggers, and environmental control than youth in the usual care group.

Section snippets

Description of intervention

The question prompt list and video intervention seeks to motivate adolescents to ask questions they have about asthma management so that they can better understand how to manage their asthma after leaving the doctor’s office. The intervention is based on Social Cognitive Theory (SCT) [[17], [18], [19]]. Self-confidence or self-efficacy is a central component of SCT. Application of SCT in pediatric asthma populations has shown that technical advice from providers is one external factor that can

Results

Forty-six providers agreed to participate in the study and 40 of these providers enrolled patients. Providers ranged in age from 28 to 62 (mean age = 41.2, standard deviation = 11.2). Twenty-seven of the 40 providers who had patients enrolled into the study were female. Four providers were Native American, three were African American, three were Asian American, 29 were White, and one was Hispanic. Forty percent of the youth saw providers who were the same race or ethnicity as themselves.

Discussion

The asthma question prompt list with video intervention resulted in children being more likely to ask one or more questions about medications, triggers, and environmental control during their visits. This is similar to prior research in the cancer area which found that when adult patients used question prompt lists they asked more questions during visits[[13], [14], [15], [16]]. In our prior work we found that only 13% of adolescents asked questions about asthma management and that the majority

Contributors’ statement

Drs. Sleath and Tudor contributed to conceptualization and the design of the study, data analysis and interpretation of data, and they drafted the initial manuscript. Scott Davis and Dr. Claire Hayes Watson contributed to data analysis and interpretation of data and they reviewed and revised the manuscript. Nacire Garcia and Drs. Lee, Carpenter, Reuland, and Loughlin contributed to the conception and design of study, acquisition of data, and they reviewed and revised the manuscript. All authors

Conflict of interest

The authors have indicated they have no financial relationships relevant to this article to disclose.

Acknowledgements

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (1402-09777). The project is registered in ClinicalTrials.gov (ID: NCT02498834, protocol ID 14–2628). Drs. Sleath and Reuland are also supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number 1UL1TR001111.

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