Factors associated with attaining coaching goals during an intervention to improve child asthma care.
OBJECTIVE
To examine parent and child characteristics associated with engagement in a coaching intervention to improve pediatric asthma care and factors associated with readiness to adopt and maintain targeted asthma management behaviors.


METHODS
Using methods based on the Transtheoretical Model, trained lay coaches worked with 120 parents of children with asthma promoting adoption and maintenance of asthma management strategies (behaviors). Coaches assigned stage-of-change (on continuum: pre-contemplation, contemplation, preparation, action, maintenance) for each behavior every time it was discussed. Improvement in stage-of-change was analyzed for association with characteristics of the participants (parents and children) and coaching processes.


RESULTS
Having more coach contacts was associated with earlier first contact (p<0.001), fewer attempts per successful contact (p<0.001), prior asthma hospitalization (p=0.021), more intruding events (p<0.001), and less social support (p=0.048). In univariable models, three factors were associated with forward movement at least one stage for all three behaviors: more coach contacts overall, fewer attempts per successful contact, and more discussion/staging episodes for the particular behavior. In multivariable models adjusting for characteristics of participants and coaching process, the strongest predictor of any forward stage movement for each behavior was having more contacts (p<0.05).


CONCLUSIONS
Improvement in readiness to adopt and maintain asthma management behaviors was mostly associated with factors reflecting more engagement of participants in the program. Similar coaching interventions should focus on early and frequent contacts to achieve intervention goals, recognizing that parents of children with less severe disease and who have more social support may be more difficult to engage.
Pediatric Emergency Medicine, The Children's Hospital of Boston, Boston, MA, USA. kyle.nelson@childrens.harvard.edu
Kyle A
KA
Nelson
Gabriele
G
Highstein
Jane
J
Garbutt
Kathryn
K
Trinkaus
Sharon R
SR
Smith
Robert C
RC
Strunk
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States