Background
Methods and design
Design and setting
Participants
Practices and physicians
Families
Recruitment and consent
Practices and physicians
Families
The intervention and control conditions
The coaching intervention
The intervention comprised
Interactions with PCPs
The coaching program
Program content
The coaches
STAGING QUESTIONS | ANSWERS | STAGE |
---|---|---|
Has your child been prescribed a controller medication (e.g., Pulmicort, Flovent or Singulair)? If yes, how often is it supposed to be given?
| No Yes | NA Continue questions |
Tell me about yesterday.
What medication(s) did you give?
What time(s)?
How about the day before that?
| Go back as far as you need to get a sense of whether the meds are being given correctly or not | |
Is the controller medication(s) used every day as directed? How often are doses missed? How many missed doses in the last week?
| If has been doing it correctly for more than 6 months | Maintenance (I STILL AM) |
Possible Questions to help answer above question
Do you have controller medications at home now?
If no, why?
Have you ever tried to use them every day? How did your child respond?
Why did you stop?
Do you think that controller medications help the asthma?
| If doing it correctly at least for the last week | Action (I AM) |
If doing it some of the time and intending to do better | Preparation (I WILL) | |
If not doing it but thinking about how to do it | Contemplation (I MAY) | |
If not doing it because bogged down | Precontemplation Believer (I CAN'T) | |
If not doing it because don't believe in giving children regular meds | Precontemplation Nonbeliever (I WON'T) |
Program delivery
The control condition
Measurements
Physician measurements
Participant measurements
Interviews
Content
Chart audits
Primary and secondary outcomes
Analytic plan
Sample size determination
Chart audits
Primary and secondary outcomes
Analytic plan
Sample size determination
Discussion
-
The coach should have shared experiences with the parents being coached. In particular, the shared experience of caring for a child with asthma is helpful in building the coaching relationship and establishing the credibility of the coaches. Parents seem to be more willing to engage with a peer coach than a nurse coach.
-
The coach should be a full-time position. Each coach works 40 hours/week including one evening until 8 pm, with no weekend calls and works the same hours each week. Defined off time is important. Flexibility of work hours has made the position available to mothers of young children. Compared to a part-time model, full time employment of the coach provides easy access for training and support, and more opportunity for the coach to book and complete parent calls.
-
Structured work hours, recurring appointments and a protocol to guide outreach efforts for parents who had missed an appointment facilitates successful contacts and use of additional communication channels (email, text messages) helps to schedule calls. Some parents are more willing to talk to the coach using cell phones rather than a landline, likely because they can verify the identity of the caller more easily via callback or text messaging to the coach's cellphone.
-
Increasing the intensity of the intervention by increasing the number of calls during the 12-month intervention increases parents' willingness to actively participate in the coaching intervention. To date, the mean number of calls/family/year is 18.24 compared to the previous study where only 15% of participants had ≥ 9 calls.
-
Ongoing training is essential: Coaches need to be knowledgeable about asthma, staging, and behavior change techniques, and have strong communication skills including reflective listening, empathy and telephone interviewing. The initial training included these skills, but ongoing monitoring and training is needed to maintain the quality of the intervention. Regular review of coaching calls (self-review, peer-review and review by managers) using a structured review tool together with written and oral feedback provides an essential learning experience for the coaches and the investigators.
-
Locating the coaches in the same physical space fosters a collegial team environment and provides opportunity for social support and immediate feedback about a difficult call.