Chaney Flashcards
key theme
external influences in shaping children’s behaviour
asthma
common lung condition causing occasional breathing problems
Adherence/ compliance
extent to which a patient correctly ‘complies’ or follows plan of medical treatment.
In this study it refers to how closely children with asthma and their parents administer asthma medication at correct dosage and times recommended by doctor.
operant conditioning
learning through association where we learn through consequences of our actions.
we form new associations and connections between certain stimuli and responses.
positive reinforcement
reinforcing stimulus following a behaviour that makes it more likely to occur again in the future. When a favourable outcome,event or reward occurs after an action that particular response/behaviour will be strengthened.
pilot study
trial run of a research study, involves only a few ps representative of target population. Conducted to test any aspect of research design with view to making improvements before conducting full research study.
Why was the study conducted?
Research consistently shown that children struggle to comply to doctors instructions to take asthma medication as often as they should. Children often find it difficult to master deep breathing techniques required to inhale correct amount of medication through normal inhalers and spacers.
However behaviour modification based on operant conditioning is one approach used by health practitioners & psychologists to improve compliance. Through rewards, makes it possible to improve way in which asthmatic children administer their medication. New inhaler was designed to test this, researchers wanted to analyse ps attitudes and behaviour towards new device; testing how positive reinforcement could increase compliance.
Aim
A pilot study to establish whether use of positive reinforcement through a specifically designed ‘funhaler’ would increase medical compliance in group of young asthmatics compared to use of conventional asthma inhaler with no additional features.
Method
Field experiment conducted in ps own home. Used repeated measures design, each child assessed twice (1st conventional asthma spacer and 2nd funhaler)
IV
conventional inhaler
Funhaler
DV
use of spacer and attitudes, collected from parents via interview using questionnaire.
Sample
32 australian children & their parents
22 male, 10 female
ps selected from patients attending clinics across large geographical area
aged between 1.5-6 years old (mean age 3.2)
average duration of asthma was 2.2 years
all ps were currently receiving treatment regularly for asthma using leading low volume spacer
Random sample.
Funhaler
Aimed to increase compliance and medication rates through key features:
-looks like toy more than conventional spacer devices, being brightly coloured
-spinning disk & whistle at the top, rewards children when inhaling and exhaling, increasing compliance (positive reinforcement)
-disk + whistle activated by child’s breathing pattern, rewarded for steady inhaling and exhaling
-Medicine is delivered in way that maximises its effectiveness
Materials
2 questionnaires-matched, items on questionnaire different but equivalent question.
Each questionnaire given by interviewing parents, one given before funhaler and one 2 weeks later.
Questionnaires consisted mainly of yes/no and fixed choice questions(most appropriate answer from predetermined list of responses).
what did questionnaires measure?
attitudes to use of inhaler and compliance to medication.
Parents were also asked about characteristics of their child, problems associated with medication and about parents and child compliance.
Procedure
1- parents of children with asthma were contacted, purpose of study was explained to them.
2- informed consent was obtained by parents before they were interviewed . They were NOT shown funhaler at this time in case it influenced their decision to take part.
3- once consented, interviewed one parent, using questionnaire and 1 was asked about attitude to existing conventional spacer they used.
4- Parents given funhaler for 2 weeks instead of current spacer, told it should be used only under adult supervision.
5- amount of usage was assessed by calling parents randomly during 2 week course of study, during call parents were asked if their child had used funhaler previous day.
6- parents were visited at end of 2 weeks and questionnaire number two was used. Parents who responded on first occasion were interviewed again and asked about their attitude and child’s attitude to Funhaler.
RESULTS- ADHERENCE
81% of children used Funhaler compared to only 59% using conventional spacer.
RESULTS- technique of medication
80% of children took 4 or more breaths using Funhaler compared to 50% breathing as well as this using the conventional spacer.
RESULTS- improvement
of the 15 children that took less than 4 breaths using conventional spacer, 11 improved with funhaler.
RESULTS- success in medication
22/30 of parents claimed they were always successful in using funhaler (73%)
compared to 3/30 success with conventional (10%)
RESULTS- improvement
19 of the parents who had been unsuccessful with conventional became ALWAYS successful when swapped to Funhaler.
RESULTS- childrens attitudes
more positive towards funhaler than conventional.
68% experienced pleasure with funhaler
only 10% with conventional
Small number of children did NOT like conventional spacers- 19% expressed strong fear/dislike whereas NO children felt this way about Funhaler.
Screams with devices
conventional: 15 (48%)
funhaler: 1 (3%)
unwilling to breathe through device at all
conventional: 19 (61%)
funhaler: 2 (7%)
unwilling to use face mask
conventional: 18 (58%)
funhaler: 1 (3%)
struggles a little
conventional: 10 (32%)
funhaler: 3 (10%)
struggles a lot
conventional: 11 (35%)
funhaler: 1 (3%)
suspicion in children
funhaler aroused more suspicion in children (10%) than conventional (0%)
parents attitudes to medicating their children
more positive with funhaler
61% said they were completely happy with funhaler
10% said they were completely happy with conventional
Negative comments on conventional, only expressed by minority.
16% said dislike conventional
0% said disliked Funhaler.
Conclusions
-improved adherence to medical device can be achieved if treatment provides rewarding experience for children
-Funhaler may be useful device in managing and treating young child asthmatics
-behaviourist techniques such as operant conditioning can be a way of improving adherence.j
