Chaney et al.

Define medical adherence

Following a particular medical regime (e.g. Taking medicine as prescribed, following a healthy diet, exercising regular, etc.)

Define pMDI

Pressurised metered dose inhaler - pressurised inhaler that delivers medication by using a propellant spray

Define spacer

A long tube (connected to MDI) the slows delivery of medication from pMDIs. Spacers make it easier for medication to reach lungs

Define frequency

How often a child takes their prescribed inhaler (e.g. two puffs, twice a day)

Outline the medical adherence background for Chaney’s study

• Poor adherance to prescribed frequency and technique remains a major problem for paediatric asthmatics on inhaled medication.

• Rates of compliance for parents offering medication regularly to asthmatic children range from 30-70% while paediatric compliance rates for the correct PMDI technique range from 39% to 67%

• Adherence does not necessarily improve with rising severity of illness

What are the background theories for Chaney?

• medical adherance

• operant conditioning (see behaviourist perspective notes)

• behaviour therapy & behaviour modification

• non-compliance

outline behaviour therapy and modification as background for Chaney’s study

(based on classical & operant conditioning)

Have been major approaches used by clinical psychologists and health practitioners to improve adherence to prescribed medical regimes

outline non-compliance as background for Chaney’s study

When patients do not follow medical advice (in the case of asthmatic children, noncompliance may be due to their caregivers not ensuring compliance, or because children felt inhalers were difficult/scary to use)

What were the aims of the study?

• This study was a pilot study to establish whether a specially designed Funhaler would increase medical adherence and compliance in a group of young children with asthma who were prescribed regular inhaler therapy

• To show that the use of a novel (new and interesting) asthma space device, the “Funhaler”, which incorporates incentive (rewarding) toys, isolated from the main inspiratory circuit by a valve, whilst not compromising drug delivery, can provide positive reinforcement, which leads to improved deterrence in young asthmatics

Evaluate the ethical considerations of the study

informed consent obtained from parents, but children were not age of consent; they may not have wanted to participate

What research method was used, and how?

Field experiment as conducted in participants' home settings in Australia

What experimental design was used? How?

Repeated measures design - each child was assessed twice in both conditions of the IV

What was the IV?

Whether child use conventional asthma spacer or Funhaler

What was the DV?

Amount of adherence to prescribed medical regime (data collected from parents by interview using a questionnaire)

What sampling method was used?

Random sampling

Evaluate the use of random sampling

not biased as choosing people at random, increases pop val

Outline the sample

• 32 children (22 male, 10 female)

• 1.5-6yrs, mean age = 3.2yrs

• Average duration of asthma = 2.2 yrs

• Prescribed drugs delivered using PMDI and spacer

• Children's parents provided informed consent and also participated in the study through completing questionnaires and taking part in phone interviews. They also helped when necessary with the use of the inhaler

Evaluate the sample

• Small sample size = more demand characteristics

• Gender bias - less generalisable to females

• Not generalisable to the whole population (e.g. older people)

• Children didn't consent themselves

• Subject to social desirability bias

How was random sampling used?

• Recruited through seven local paediatric tuition/GP clinic, spanning a wide area with a radius of 51 km

• Parents were initially contacted by study coordinator by telephone before being visited at home

What materials were used

• Funhaler incorporate a number of features to distract attention of children from drug to delivery event itself, and to provide means of self reinforcing use of effective technique

• Funhaler make spaces appealing to children using incentive toys; spinner and whistle

• In order to get the most effective medication, child must breathe deeply, so Funhaler is designed so that toys work best (whistle blows louder, spinner spins faster) when child breathes deeply. If child gets bored of toys, they can replace with a range of different toys

Evaluate the validity of the study

• Random sampling used - not biased, choosing people at random - increases population validity

• Subject to social desirability bias

• Order effects were not controlled

• Trial was short term, positive attributes expressed by parents could be related to the novelty of the device. Results do not tell us about long-term success of device

Outline the procedure

• Firstly, comparisons made between aerosol output of standard/small volume spacer device (235ml Breath-a-tech) and a 225ml Funhaler. Overall, no significant differences were observed, so comparison was complementary, indicating the use of Funhaler rather than standard inhaler, does not compromise drug delivery

  • This was necessary so that any differences in adherence are not confounded by differences in drug delivery

• Participants were then asked to use Funhaler instead of the normal PMDI and space inhaler to administer the medication

• March question as were completed by parents after sequential use of Breath-a-Tech and Funhaler

  • First question completed before use of Funhaler

  • Second question now completed after two weeks use of Funhaler

• Data collected from self reports related to how easy each device was to use, compliance of parents and children (how well they followed doctors instructions for taking medication) on treatment attitudes

• During the course of the study, each parent was called at random to find out whether they'd attempted to medicate their child the day before

outline the questionnaire used

• most questions were fixed response, closed questions whereby parents could indicate “yes” or “no” answer, or select most appropriate answer from predetermined list of responses e.g.

  • “did you medicate your child yesterday” yes / no

  • “if not always successful in using the device, what problems are experienced by the child when using the device?”

  • 1. no problems (always successful)

  • 2. unwilling to use mask

  • 3. unwilling to breathe through device at all

  • 4. breathes through device, but not deeply

  • 5. unwilling to breathe for very long through device

  • 6. struggles a little

  • 7. struggles a lot

  • 8. screams when device is brought close to face

what are the weaknesses of the questionnaire?

• no “other” option

  • fixed/closed questions - cant elaborate

evaluate the use of a field exp

causal conclusions can be drawn about effect of conventional spacer vs Funhaler on compliance rates towards use of spacer device

evaluate the use of a repeated measures design

• controls for the effect of extraneous variables

• order effects: Funhaler was always used second, ideally a cross-over design should be used when testing medication

outline the results of the study

• use of Funhaler was associated with improved parental and child compliance

• When surveyed randomly, 38% more parents were found to have medicated their children the previous day when using Funhaler, compared to their existing small volume spacer device

• 60% children recommended 4 or more cycles per aerosol delivery when using Funhaler compared with standard/small volume spacer

• significantly more parents reported they were always successful medicating their child using Funhaler compared to their exisiting device

outline the conclusions drawn from the results of Chaney’s study

• improved adherance, combined with satisfactory delivery characteristics, suggest that the Funhaler may be useful for management of young asthmatics

• use of Funhaler could possibly be translated to improved measures of clinical outcome (could produce better health prospects in long-term for children with asthma)

• use of functional incentive device such as Funhaler may improve health of children

• more research is recommended on long-term efficacy of this treatment