|Titel||Ontwikkeling en evaluatie van een voorlichtings-interventie gericht op de optimalisering van het volgen van maatregelen ter preventie van astma bij kinderen met een familiaire allergische dispositie|
|Looptijd||03 / 2000 - 11 / 2004|
Worldwide the prevalence of asthma in children is high and seems to be still growing. This trend can also be observed in the practice populations of general practitioners in the Netherlands. In order to reduce the (chronic) morbidity of asthma and the concomitant expenses for the supply of care, it is important that parents of children with a high risk of developing asthma make use of reliable, simple and effective methods to prevent the clinical manifestation of asthma. Familial disposition is defined as the occurrence of asthma in first-degree relatives. The presence of asthma in parents, brothers or sisters is known to and registered by general practitioners in the (extended) Registration Network of General Practitioners (RNFP). This (extended) RNFP consists of the practices of 67 general practitioners, covering a total population of 140,000 patients.
This research proposal is a follow-up of AF-project 96.34 'Compliance of different measures to prevent the development of asthma in children with a genetic allergic disposition'. The purpose of that project was to investigate the effectiveness of preventive measures on the respiratory morbidity in the first year of life of the target group. In that project, parents were asked to conduct: 1) measures to prevent exposure to allergens (such as house dust mite and cat and dog allergens ) and other irritants (smoke), and 2) breast-feeding or hypo-allergen feeding of the child and postponement of solid food. It appears from the evaluation of nurses providing this education to the parents that the parents were having difficulties with measures such as smoking cessation, sanitation or breast-feeding because of specific barriers. AF-project 96.34 did not aim to investigate these important determinants nor did it determine the reasons for non-adherent behaviour; only the adherence rate itself was assessed. The preventive programme was based on the available literature, and the educational programme was 'written behind the desk', which was necessary as there was no previous experience with such a preventive programme combining several preventive measures against asthma in children. However, at this moment the parents of AF-project 96.34 are still following the preventive programme, and the education can now be evaluated. Therefore, the overall aim of this commissioned study is to develop and evaluate an optimal individual education, in order to provide a tailor-made education to parents. This education will be based on the needs assessment of the target group and has to address the specific barriers individual parents experience in performing the preventive measures involved.
The research programme is divided into different phases. In Phase 1A, 50 randomly selected parents who participated in AF-project 96.34 and who were advised to take preventive measures will be examined by means of focus-group interviews to investigate which determinants (such as attitude, social influence and self-efficacy) have influenced their actual adherence behaviour. Focus groups will be helpful to gain insight into the parents' view on the recommended preventive measures. From the results of the focus-group interviews, educational materials (leaflets/folders) will be written on the basis of the determinants of the prevention behaviour of the study population (Phase 1B). The educational message given by the health workers involved will be refined in such a way that the beliefs, (im)possibilities, attitudes and socially important determinants of the individual parents will be taken into account as best as possible. Earlier studies in children with asthma have shown that with a programme based on the outcome of needs assessment, significantly higher positive outcomes can be expected. Educational messages based on needs assessment are especially effective because of the attention being paid to the parents' individual needs. The education will focus on smoking behaviour, baby feeding, sanitation advice, and the presence of pets, tailored to the specific conditions of the specific parents expecting a baby with a high risk of developing asthma. In the second phase the refined prevention education will be recommended to 50 newly selected parents (intervention group), who are expecting a child with a high risk of developing asthma. These parents did not participate in AF-project 96.34. Another 50 persons will serve as controls and receive the usual care. Phase 2 consists of the evaluation of the effects of the renewed education given by community health nurses (in writing and orally) on the degree of adherence to the advised measures. Besides measuring adherence by assessment of CO, cotinine (if necessary), and house dust mite and pet allergen concentrations, determinants of preventive behaviour will be measured through a questionnaire. These measurements will be done in both groups. The outcomes of the present proposal will provide further insight into the determinants of adherence (Phase 1) as well as the extent of improved adherence produced by the new educational programme (Phase 2). The effect of this tailor-made programme on morbidity is seen as the ultimate goal which can be more effectively reached when the refined preventive programme is implemented in the health care setting of the Netherlands. On the basis of a scenario study, we will extrapolate what effects a higher adherence rate could have on the reduction in asthma morbidity. This will be part of the present project.
|Onderzoeker||Prof.dr. J.A. Knottnerus|
|Onderzoeker||Dr. E.P.E. Mesters|
|Onderzoeker||Dr. J.W.M. Muris|
|Onderzoeker||Dr. H.J.A.M. Schonberger|
|Onderzoeker||Prof.dr. H. de Vries|
|Onderzoeker||Prof.dr. E.F.M. Wouters|
|Projectleider||Prof.dr.ir. C.P. van Schayck|
|D24200||Preventieve gezondheidszorg, GVO|
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