Results Summary
What was the research about?
Asthma is the most common chronic illness among youth in the United States. Asthma attacks can cause youth to miss school and their caregivers to miss work. Managing asthma well can help prevent attacks.
Research on other illnesses shows that having a set of common questions, called a prompt list, before a clinic visit may get patients more involved with their doctors. In this study, the research team wanted to learn if giving youth ages 11–17 a prompt list helped get them more involved in clinic visits and better manage their asthma.
What were the results?
Compared with patients who didn’t receive the prompt list, those who did were more likely to
- Ask doctors questions
- Receive information about asthma from doctors
- Say doctors involved them in clinic visits
After 12 months, patients who did and didn’t receive the prompt list had similar
- Asthma control
- Quality of life related to their asthma
- Confidence in their ability to manage asthma
The two groups didn’t differ in
- How satisfied they were with their clinic visits
- If they took medicine correctly
- How well their lungs worked
- Patient-reported medicine problems, such as side effects or understanding directions
- Emergency room visits
- Unscheduled clinic visits
Who was in the study?
The study included 359 youth with asthma. Patients received care at four primary care clinics in North Carolina. Among the patients, 37 percent were African American, 36 percent were white, 13 percent were Hispanic, and 11 percent were Native American. The average age was 13, and 57 percent were boys. Patients had lived with asthma for an average of 10 years.
What did the research team do?
The research team assigned youth by chance either to receive the prompt list plus a supporting educational video before their clinic visit or to receive nothing. The prompt list included common questions about asthma medicine, triggers, and ways to avoid triggers.
Youth who received the prompt list watched the video on a tablet while waiting for their visit to start. The video focused on the importance of youth being involved during visits and how the prompt list could help. Next, the patients marked questions they wanted to ask on the prompt list. They could give their prompt list to their doctor at the beginning of the visit or use it to remember questions they wanted to ask.
The research team recorded all visits at the start of the study and again 6 and 12 months later. After visits, the team interviewed all youth about their visit and asthma management. Youth who received the prompt list filled it out again before their 6- and 12-month visits. The team repeated the interviews and surveys after those visits.
Youth with asthma, caregivers, and doctors helped design the prompt list and video and gave feedback throughout the study.
What were the limits of the study?
Patients received care from primary care clinics in North Carolina. Also, the study included youth with and without well-controlled asthma. Results may differ in other settings or with only patients whose asthma is poorly controlled. Future research could test asthma prompt lists in these situations.
How can people use the results?
Health clinics could use the results when considering ways to help get youth with asthma more involved in clinic visits.
Professional Abstract
Objective
To assess the effectiveness of a prompt list of questions about asthma plus a supporting educational video in increasing youth involvement during medical visits and improving asthma management and quality of life
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 359 youth ages 11–17 with asthma |
| Interventions/ Comparators |
|
| Outcomes |
Primary: asthma control, asthma management self-efficacy, asthma-related quality of life Secondary: youth question asking, provider education of youth about asthma, provider inclusion of youth input, youth rating of clinicians as participatory, adolescent satisfaction with medical visit, adherence to asthma medications, youth-reported medication problems, ED visits, unscheduled physician visits, lung function |
| Timeframe | 1-year follow-up for primary outcomes |
This randomized controlled trial examined the effectiveness of a prompt list plus a supporting educational video in increasing involvement during medical visits and improving health outcomes among youth ages 11–17 with asthma. The prompt list had common questions about asthma medications, triggers, and environmental control, which these patients could ask during their medical visits.
The research team randomly assigned patients to either the prompt list group or the control group. In the prompt list group, patients watched the educational video on a tablet during their pre-visit wait time. The video focused on the importance of youth being involved during visits and using the prompt list. Next, the patients marked questions they wanted to ask on the prompt list. They could give the completed prompt list to their provider at the beginning of the visit or refer to the list to help remember which questions they wanted to ask. In the control group, patients received no intervention before their medical visit.
The study included 359 youths with asthma who received care at four clinics in North Carolina. Among these patients, 37% were African American, 36% were white, 13% were Hispanic, and 11% were Native American. The average age was 13, and 57% were male. Patients had lived with asthma for an average of 10 years.
The research team recorded medical visits at baseline and again 6 and 12 months later. After medical visits, the team interviewed all youth on the study outcomes. Youth who received the prompt list completed it again before their 6- and 12-month follow-up visits. The team repeated the interviews and surveys after those visits.
Youth with asthma, caregivers, and primary care clinicians helped design the study, including the prompt list and educational video.
Results
After one year, asthma control, asthma-related quality of life, and asthma management self-efficacy did not differ between the prompt list and control groups.
Compared with patients in the control group, those in the prompt list group were more likely to ask questions about asthma, receive education on asthma, and rate their clinician as participatory (all p≤0.05). The two groups did not differ in the other secondary outcomes.
Limitations
Patients received care at primary care clinics in North Carolina. The study included youth with and without well-controlled asthma. Results may differ in other settings or specifically among youth whose asthma is poorly controlled.
Conclusions and Relevance
Among youth with asthma, the prompt list plus supporting educational video did not improve asthma management or health outcomes. However, the prompt list improved youth question asking and education given by clinicians during medical visits.
Future Research Needs
Future research could consider testing the effectiveness of prompt lists in different settings or specifically among patients whose asthma is poorly controlled.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers said the report needed to appropriately emphasize all assessed outcomes and not overstate significant findings or downplay null results. Specifically, the reviewers told the researchers to first report the results for their primary outcomes, even if those were less interesting than the secondary results. In response, the researchers revised the abstract and added a table to present the differences for all primary and secondary outcomes between the two study arms. The researchers also commented on the clinical importance of the differences observed, not only the statistical importance, as the reviewers requested. The researchers noted that they had analyzed all primary and secondary outcomes as as planned in their PCORI award, but they had conducted additional analyses to clarify asthma control and quality of life results.
- The reviewers asked for a description of the qualitative research methods and results. The researchers added this material, which was previously published.
- The reviewers expressed concern about the methods used in analyzing results from the randomized trial, specifically questioning the methods used to handle missing data and covariates. The researchers said that they involved a statistician in the project from the outset, and they are confident about how they handled missing data. They explained that they did not use multiple imputation with primary outcomes, which had very few missing values. The majority of missing covariates resulted from participants skipping a question on a survey, and they used single imputation for these missing values. The researchers added that the results did not drive the selection of covariates, but that the covariates followed the original analysis plan.
- The reviewers noted that they included many participants in analyses even when participants missed their six-month study visits. The researchers explained that they planned to do the six-month visits at participants’ homes, but that the study was seriously disrupted by a hurricane so many of these visits were not possible.