A randomized clinical trial of a culturally responsive intervention for African American women with asthma.

BACKGROUND: Few interventions have focused on the difficulties that African American women face when managing asthma. OBJECTIVE: To evaluate a telephone-based self-regulation intervention that emphasized African American women's management of asthma in a series of 6 sessions. METHODS: A total of 422 African American women with persistent asthma were randomly assigned to either an intervention or control group receiving usual care. Behavioral factors, symptoms and asthma control, asthma-related quality of life, and health care use at baseline and 2 years after baseline were assessed. Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes. RESULTS: Compared with the control group, those who completed the full intervention (6 sessions) had significant gains in self-regulation of their asthma (B estimate, 0.73; 95% CI, 0.17-1.30; P < .01), noticing changes to their asthma during their menstrual cycle (B estimate, 1.42; 95% CI, 0.69-2.15; P < .001), and when having premenstrual syndrome (B estimate, 1.70; 95% CI, 0.67-2.72; P < .001). They also had significant reductions in daytime symptoms (B estimate, -0.15; 95% CI, -0.27 to -0.03; P < .01), asthma-related hospitalization (B estimate, 0.51; 95% CI, 0.00-1.02; P < .05), and improved asthma control (B estimate, 1.34; 95% CI, 0.57-2.12; P < .001). However, neither grouped changed over time in outcomes. CONCLUSION: Despite high comorbidity, African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group. Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term. TRIAL REGISTRATION: clinicaltrials.gov Identifier NCT01117805.

Study protocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training.

BACKGROUND: Massive resources are expended every year on cross-cultural communication training for physicians. Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America. There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians. There is a need to understand the added benefit of such training compared to more general communication. We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients. The current study aims to answer this question by enhancing the Physician Asthma Care Education (PACE) program to cross cultural communication (PACE Plus), and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma. METHODS/DESIGN: A three-arm randomized control trial is used to compare PACE Plus, PACE, and usual care. Both PACE and PACE Plus are delivered in two, two-hour sessions over a period of two weeks to 5-10 primary care physicians who treat African American and Latino/Hispanic children with asthma. One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma. Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group. The comparative effectiveness of PACE and PACE Plus on clinician's therapeutic and communication practices with the family/patient, children's urgent care use for asthma, asthma control, and quality of life, and parent/caretaker satisfaction with physician performance will be assessed. Data are collected via telephone survey and medical record review at baseline, 9 months following the intervention, and 21 months following the intervention. DISCUSSION: This study aims to reduce disparities in asthma outcomes among African American and Latino/Hispanic children through cross-cultural communication training of their physicians and assessing the added value of this training compared to general communication. The results of this study will provide important information about the value of cross-cultural training in helping to address persistent racial disparities in outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01251523 December 1, 2010.