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Meta-Analysis of Adherence Promotion Interventions in Pediatric Asthma
Andrea Fidler1, Rachel Sweenie1, Adrian Ortega2
1Department of Clinical & Health Psychology, University of Florida.
Insights
Interventions effectively improve inhaled corticosteroid (ICS) adherence in pediatric asthma patients. Further research is needed to understand long-term effectiveness and identify optimal strategies for promoting ICS adherence.
Area of Science:
- Pediatric Pulmonology
- Behavioral Science
- Health Services Research
Background:
- Suboptimal adherence to inhaled corticosteroids (ICS) is common in youth with asthma.
- Systematic evaluation of ICS adherence promotion interventions is critical for identifying effective strategies.
Purpose of the Study:
- Quantify the effectiveness of interventions on ICS adherence in pediatric asthma.
- Explore how intervention and study characteristics influence effect sizes.
- Characterize the risk of bias in these interventions.
Main Methods:
- Conducted literature searches across five databases for studies published after 1997.
- Included studies quantitatively measured ICS adherence in youth (<18 years) with asthma.
- Analyzed aggregate effect sizes and moderator variables using random-effects models and assessed risk of bias with the Cochrane Collaboration tool.
Main Results:
- Thirty-three studies showed a small but significant aggregate effect size for ICS adherence promotion interventions post-intervention (g=0.39).
- Effect size at follow-up was not statistically significant (g=0.38).
- Intervention format and adherence measurement method were significant moderators; most interventions had high performance bias risk.
Conclusions:
- ICS adherence promotion interventions demonstrate effectiveness in youth with asthma.
- Longitudinal research is needed for precise long-term effectiveness measures.
- Reassessment of moderators is recommended as the literature expands.
Background:
Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective.
Objective:
This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions.
Methods:
We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool.
Results:
Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24-0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = -0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains.
Conclusions:
ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.
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