Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Abstract

Background: Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes.

Objective: This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents.

Methods: A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents.

Results: Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings.

Conclusions: Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

Keywords: Adolescents; Asthma; Childhood asthma; Outcome assessment (health care); Schools.

Figure 1. Search Strategy Text Box

This figure describes the search strategy implemented to execute this systematic review.

Figure 2. Consort Diagram

This diagram illustrates article inclusion and exclusion criteria for this systematic review.

Figure 3. Study Intervention Level Flow Diagram

This diagram illustrates the distribution of studies across the intervention levels.

Figure 4. Specific Intervention Level Chart

This chart groups the studies according to the specific intervention levels: child only, child and family, child and medical system, child and community, and child, family, and medical system.