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Change in health outcomes for First Nations children with chronic wet cough: rationale and study protocol for a
Pamela J Laird1,2,3, Roz Walker4,5,6, Gabrielle McCallum7
1Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia.
Insights
A new culturally integrated program aims to improve early health-seeking for children's chronic wet cough and enhance clinical management. This intervention seeks to prevent protracted bacterial bronchitis (PBB) progression to bronchiectasis, improving lung health in First Nations children.
Area of Science:
- Pediatric Pulmonology
- Implementation Science
- Public Health
Background:
- Chronic wet cough in children can indicate serious lung conditions like protracted bacterial bronchitis (PBB) and bronchiectasis.
- Early diagnosis and management of PBB are crucial to prevent progression to irreversible bronchiectasis.
- Effective intervention requires timely healthcare-seeking by caregivers and adept clinical management.
Purpose of the Study:
- To enhance caregiver health-seeking behaviors for pediatric chronic wet cough.
- To improve clinician management of chronic wet cough in children.
- To reduce the long-term burden of bronchiectasis by preventing PBB progression.
Main Methods:
- A multi-center, pseudorandomized, stepped wedge trial design.
- Implementation of a culturally integrated program with knowledge dissemination and adaptation components.
- Utilizing Aboriginal Participatory Action Research and Implementation Science, guided by the Consolidated Framework for Implementation Research.
- Measuring health-seeking behavior, parent-proxy Cough-specific Quality of Life (PC-QoL), and other health, cost, and implementation outcomes.
Main Results:
- Hypothesized improvement in caregiver health-seeking for chronic wet cough.
- Expected enhancement in clinician management of pediatric chronic wet cough.
- Anticipated improvement in lung health outcomes for affected children.
Conclusions:
- A tailored, culturally integrated intervention is hypothesized to improve health-seeking and clinical management for chronic wet cough in children.
- The program aims to positively impact the lung health of First Nations children.
- Successful implementation may decrease the future incidence of bronchiectasis by preventing PBB progression.
Background:
In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences. However, detection and management require timely health-seeking by carers and effective management by clinicians. We aim to improve (a) carer health-seeking for chronic wet cough in their child and (b) management of chronic wet cough in children by clinicians. We hypothesise that implementing a culturally integrated program, which is informed by barriers and facilitators identified by carers and health practitioners, will result in improved lung health of First Nations children, and in the future, a reduced the burden of bronchiectasis through the prevention of the progression of protracted bacterial bronchitis to bronchiectasis.
Methods:
This study is a multi-centre, pseudorandomised, stepped wedge design. The intervention is the implementation of a program. The program has two components: a knowledge dissemination component and an implementation component. The implementation is adapted to each study site using a combined Aboriginal Participatory Action Research and an Implementation Science approach, guided by the Consolidated Framework of Implementation Research. There are three categories of outcome measures related to (i) health (ii) cost, and (iii) implementation. We will measure health-seeking as the proportion of parents seeking help for their child in a 6-month period before the intervention and the same 6-month period (i.e., the same six calendar months) thereafter. The parent-proxy, Cough-specific Quality of Life (PC-QoL) will be the primary health-related outcome measure.
Discussion:
We hypothesise that a tailored intervention at each site will result in improved health-seeking for carers of children with a chronic wet cough and improved clinician management of chronic wet cough. In addition, we expect this will result in improved lung health outcomes for children with a chronic wet cough.
Trial Registration:
Australian New Zealand Clinical Trials Registry; ACTRN12622000430730 , registered 16 March 2022, Retrospectively registered.
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