The Development and Preliminary Testing of a Dyadic Brief Shared Decision-Making and Motivation Interviewing...

Introduction:Shared decision-making (SDM) interventions have been shown to improve asthma control in adults but are less studied in pediatric-caregiver dyads. Because asthma imposes a disproportionate burden on Black and Hispanic adolescents, we adapted an adult asthma SDM intervention to minoritized dyads.Materials and Methods:Focus groups informed adaptation of the intervention. Feasibility, for example, intervention fidelity, and clinical outcomes, for example, effect of the active intervention on shared decision-making (SDM-9) scores and Asthma Control Questionnaire (ACQ) scores were assessed. Post-trial interviews assessed acceptability of study components based on implementation metrics.Results:Nine focus groups were conducted with 25 adolescents (36% female; 84% Hispanic; mean age = 12.7 years) and 20 caregivers (95% female; 90% Hispanic; mean age = 39.8 years) to adapt the intervention to dyads. Sixty adolescents (aged 10-14 years; 53% female; 77% Hispanic; mean age = 11.3 years, caregivers (90% female; 77% Hispanic; mean age = 39.4 years), and dyads were enrolled in the trial. Clinician interventionists (n = 7) were randomized to the active SDM or dose-matched attention control condition. Feasibility was demonstrated by high fidelity to intervention delivery, high retention of subjects, and high rates of data collection. No outcomes were significant for example, ACQ: β = 0.15, 95% confidence interval -0.22, 0.51, P = 0.43, although adolescents in the active arm reported higher SDM scores relative to controls (β = 3.35 P = 0.14). Adolescents, caregivers, and clinicians completing posttrial interviews found the study acceptable.Discussion:The intervention was feasible and acceptable. Although no significant health improvements were detected, targets for future refinements, for example, in-person-only intervention delivery and enrollment of younger children, warrant testing to determine if a dyadic SDM may be a useful patient-centered strategy for underserved pediatric populations.Contribution to the Literature:While an SDM intervention was feasible and acceptable, refinements are needed to translate SDM improvements to behavior change that impact asthma outcomes.