CL Joseph et al. Factors Associated With Nonresponse to a Computer-Tailored Asthma Management Program for Urban Adolescents With Asthma. Journal of Asthma, July 20, 2010.

The ability to identify potentially resistant participants early in the course of an intervention could permit development of strategies for behavior change and improve program effectiveness. The objective of an analysis by Joseph and colleagues was to identify factors related to nonresponse (i.e., lack of behavior change) to an asthma management intervention for urban teenagers. The intervention targeted several behaviors, including medication adherence, having a rescue inhaler nearby, and smoking. A discriminate analysis was conducted using data from a randomized trial of the intervention. Included in this analysis were participants who: (a) reported a physician diagnosis of asthma, (b) ompleted a baseline questionnaire, (c) were randomized to the treatment group, (d) attended >/=2 of 4 educational sessions, and (e) completed >/=2 of 3 follow-up questionnaires. Ninety students met criteria for inclusion in this subgroup analysis. In logistic regression models for medication adherence, nonresponse was related to low baseline asthma self-regulation, odds ratio = 3.6 (95% confidence interval = 1.3-9.5). In models for having an inhaler nearby, nonresponse was related to low baseline self-regulation and to rebelliousness, OR = 4.7 (1.6-13.2) and 5.6 (1.7-18.0), respectively. Nonresponse to smoking messages was related to rebelliousness, low emotional support, and low religiosity, ORs = 7.6 (1.8-32.3), 9.5 (1.4-63.5), and 6.6 (1.5-29.8) respectively.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Certain variables showed the ability to discriminate the likelihood of response from that of nonresponse to an asthma program for urban, African American adolescents with asthma. These variables can be used to identify resistant subgroups early in the intervention, allowing the application of specialized strategies through tailoring.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER:
The study shows behaviors you need to alter before entering a self-management program for asthma (and likely any other chronic disorder). Lack of self-control at the outset means you are apt to receive little benefit from the specific self-management skills you are taught.