Helping Hispanic teens find their voice in asthma care

A $3.6 million study will test whether a simple pre-visit intervention can help Hispanic youth take a more active role in their asthma care.

For a teenager living with asthma, a doctor's visit can be an important opportunity to ask questions, understand treatment, and learn how to better manage the disease. But young patients do not always know what to ask or feel uncomfortable speaking up.

A new five-year, $3.6 million grant from the National Institute on Minority Health and Health Disparities will allow UNC-Chapel Hill researchers and their partners to test a simple approach to changing that for Hispanic youth with uncontrolled asthma.

The study will enroll 276 English- and Spanish-speaking Hispanic youth ages 11 to 17 at five practices in North Carolina and Georgia. Before their visit, youth in the intervention group will watch a short video about the importance of being actively involved in their care and receive a one-page question prompt list. They can use the list to identify questions they want to ask their healthcare provider.

Researchers will examine whether greater participation during the medical visit leads to better asthma control and quality of life over 12 months. They will also study whether youth who are more engaged receive more education from their providers and develop greater confidence in managing their asthma.

The approach builds on years of research led by UNC Eshelman School of Pharmacy's Betsy Sleath, PhD, George H Cocolas Distinguished Professor and Regional Associate Dean for Eastern North Carolina. Earlier work by Sleath and colleagues found that a video and question prompt list could increase youth question-asking and provider education during asthma visits. Also, youth in the intervention group who asked questions were more likely to experience improvements in asthma control and quality of life.

Now, the team is taking the next step and testing whether the intervention can help address persistent asthma disparities among Hispanic youth.

“Research has found that Hispanic youth are more likely to have asthma-related emergency department visits and hospitalizations and worse health outcomes. Hispanics are 40% more likely to die of asthma than their non-Hispanic counterparts," said Sleath. "Our hope is that youth who receive the intervention will ask more questions about their asthma to improve their understanding of managing it which should lead to improved health outcomes.”

The multidisciplinary team includes UNC Health pediatric allergist and immunologist Michelle Hernandez, MD; School of Pharmacy behavioral researcher and respiratory therapist Delesha Carpenter, PhD, data analyst Izabela Annis, MS, and project manager Nacire Garcia, MS; Augusta University statistician Kevin Dobbin, PhD; and Monica Jolles, PhD, a University of Colorado expert in patient activation and research with Hispanic families.

Henry Young, PhD, Vice Provost for Academic and Community Engagement at the University of Georgia (UGA), will lead recruitment efforts and the UGA subcontract. The partnership will bring together researchers and clinical practices in both states, including three practices in eastern North Carolina and two in Georgia.

"Our collaboration brings together strengths of our institutions to help young people with asthma build the confidence and skills they need to engage in their care and improve their well-being," said Young.

If successful, the intervention could offer a practical, low-cost way to help Hispanic young people become active participants in their own care.