Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study

Hsiang Shonna Yin, Ruchi S. Gupta, Alan L. Mendelsohn, Benard Dreyer, Linda van Schaick, Christina R. Brown, Karen Encalada, Dayana C. Sanchez, Christopher M. Warren, Suzy Tomopoulos

Research output: Contribution to journalArticle

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Abstract

Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2–0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06–0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.

LanguageEnglish (US)
Pages919-929
Number of pages11
JournalJournal of Asthma
Volume54
Issue number9
DOIs
StatePublished - Oct 21 2017

Fingerprint

Asthma
Parents
Pediatrics
Emergencies
Odds Ratio
Health Literacy
Vital Signs
Albuterol
Ambulatory Care Facilities
Literacy
Logistic Models
Regression Analysis
Confidence Intervals

Keywords

  • Asthma action plan
  • health literacy
  • patient education
  • pictogram

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Yin, Hsiang Shonna ; Gupta, Ruchi S. ; Mendelsohn, Alan L. ; Dreyer, Benard ; van Schaick, Linda ; Brown, Christina R. ; Encalada, Karen ; Sanchez, Dayana C. ; Warren, Christopher M. ; Tomopoulos, Suzy. / Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management : A randomized controlled study. In: Journal of Asthma. 2017 ; Vol. 54, No. 9. pp. 919-929
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abstract = "Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3{\%}, p = 0.03; adjusted odds ratio [AOR] = 0.5[95{\%} confidence interval: 0.2–0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1{\%}, p < 0.001; AOR = 0.1 [0.06–0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1{\%}, p = 0.5). Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.",
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author = "Yin, {Hsiang Shonna} and Gupta, {Ruchi S.} and Mendelsohn, {Alan L.} and Benard Dreyer and {van Schaick}, Linda and Brown, {Christina R.} and Karen Encalada and Sanchez, {Dayana C.} and Warren, {Christopher M.} and Suzy Tomopoulos",
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Yin, HS, Gupta, RS, Mendelsohn, AL, Dreyer, B, van Schaick, L, Brown, CR, Encalada, K, Sanchez, DC, Warren, CM & Tomopoulos, S 2017, 'Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study' Journal of Asthma, vol. 54, no. 9, pp. 919-929. DOI: 10.1080/02770903.2016.1277542

Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management : A randomized controlled study. / Yin, Hsiang Shonna; Gupta, Ruchi S.; Mendelsohn, Alan L.; Dreyer, Benard; van Schaick, Linda; Brown, Christina R.; Encalada, Karen; Sanchez, Dayana C.; Warren, Christopher M.; Tomopoulos, Suzy.

In: Journal of Asthma, Vol. 54, No. 9, 21.10.2017, p. 919-929.

Research output: Contribution to journalArticle

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T1 - Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management

T2 - Journal of Asthma

AU - Yin,Hsiang Shonna

AU - Gupta,Ruchi S.

AU - Mendelsohn,Alan L.

AU - Dreyer,Benard

AU - van Schaick,Linda

AU - Brown,Christina R.

AU - Encalada,Karen

AU - Sanchez,Dayana C.

AU - Warren,Christopher M.

AU - Tomopoulos,Suzy

PY - 2017/10/21

Y1 - 2017/10/21

N2 - Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2–0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06–0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.

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