chaney et al Flashcards
aim
To test whether an asthma spacer device known as a
‘Funhaler’ could provide positive reinforcement to improve
adherence in child asthmatics compared to devices in current use.
method
The research method was a field experiment using a
repeated measures design. The independent variable was the
type of device used: a standard spacer device (a ‘Breath-a-Tech’
or ‘AeroChamber’) or a novel device known as the ‘Funhaler’. The
dependent variable was the compliance level to the prescribed
medical regime. The sample consisted of 32 children who
were instructed to use a Funhaler instead of their normal pMDI
(pressurised metered dose inhaler) and spacer inhaler to administer
their medication. The Funhaler used a number of features to
distract the attention of children from the drug delivery and to reinforce correct use of the device. Parents of participants then
completed questionnaires after use of the standard inhaler and the
Funhaler.
results
The findings showed that compliance was higher when
using the Funhaler, with children showing greater satisfaction and
willingness to use the Funhaler compared to the standard inhaler.
Parents’ attitudes towards medicating their children were also
more positive when using the novel device.
conclusion
The Funhaler may be useful as a functional incentive
device that could improve compliance to medical regimes in young
asthmatics.
key term : complaince
The term ‘compliance’ in this study means
the extent to which a patient correctly
‘complies’ or follows a plan of medical
treatment. In this study it refers to how
closely young children with asthma and their
parents administer asthma medication at the
correct dosage and times recommended by
their doctors. The words ‘compliance’ and
‘adherence’ are used interchangeably in this
study. There is, however, some debate around
describing a patient as ‘non-compliant’, as
it seems to imply ignorance or deliberate
defiance of medical advice. In fact, research
shows there are many complex factors which
reduce medical compliance, including the
high costs of medication, negative side-
effects, and poor communication between
doctors and patients.
CONTEXT
Low rates of medical compliance are a current issue in the healthcare system. This
is because it is linked to increased emergency hospital admissions and mortality
rates for patients. For asthmatics this is particularly relevant as use of medication
through traditional inhalers is designed to both prevent and relieve attacks.
Classic research has consistently shown that young children struggle to comply
with doctors’ instructions to take asthma medication as often as they should. Rates
of compliance for offering medication regularly to asthmatic children range from
30 to 70% (Smith et al., 1984). Additionally, Celano et al. (1998) found that children
often find it difficult to master the deep breathing technique required to inhale the
correct amount of their medication through normal inhalers and spacers. These
two issues combined mean that a sizeable proportion of young children do not
manage to inhale any medication at all.
Recent studies, such as that by Chapman et al. (2000), have identified
various reasons why children are particularly poor at taking medication. These
include ignorance, fear, boredom, forgetfulness and apathy. However, behaviour
modification based on operant conditioning is one approach used by health
practitioners and psychologists to improve compliance. Through use of rewards
it might be possible to improve the way in which asthmatic children administer
their medication. Chaney et al. proposed that children’s sensitivity to positive
reinforcement could be used to good effect in designing a new inhaler device.
Researchers in this study wanted to analyse participants’ attitudes and behaviour
towards the new device; testing positive reinforcement could increase compliance.
key term : operant conditioning
Operant conditioning is a form of
associative learning, whereby we learn by the
consequences of our actions. We form new
associations and connections between certain
stimuli and responses. When we complete a
behaviour that has a positive outcome, we are
more likely to repeat that action. For example,
parents might entice children to complete
their homework by offering a tasty snack as
a reward. When the child completes their
work, they are then rewarded with the snack.
This process is known as reinforcement. It
can be a powerful strategy used to shape the
behaviour of both humans and animals.
AIM
The aim of this study was to test whether use of positive reinforcement via the
Funhaler could improve medical compliance in young asthmatics, compared to
use of a conventional asthma inhaler with no additional features.
METHOD - participants
The study involved 32 children: 22 male and 10 female. The age range was
1.5–6 years, with a mean age of 3.2 years and average duration of asthma of 2.2
years. The sampling technique was a random sample of asthmatic children who
had been prescribed drugs delivered by pMDI and spacer (pressurised metered
dose inhaler) and were recruited from clinics across a large geographical area.
METHOD
The research method was a field experiment which used a repeated measures
design. The independent variable (IV) was the device used to administer the
asthma drugs. The researchers compared standard small-volume spacer devices,
including the ‘Breath-a-Tech’ and ‘AeroChamber’, with a novel device known as a
‘Funhaler’. The dependent variable (DV) was how well participants complied with
their prescribed medical regime, measured through parental responses to a self-
report questionnaire.
METHOD - design and procedure
The study was undertaken in participants’ homes over a two week period. The
children’s parents gave informed consent to take part and completed a structured,
closed question questionnaire with an interviewer about their child’s current
asthma device. This included questions on both the parent’s and child’s attitudes
towards medication and their compliance levels. Participants were then asked to
use a Funhaler instead of their normal pMDI and spacer inhaler to administer their
medication without further instructions on use, except that parental guidance
was required. The ‘Funhaler’ incorporated the standard pMDI inhaler and spacer
that you may be familiar with (see Figure 3.4 on page 91), along with an additional
attachment. The attachment included incentive toys such as a spinning disc and
whistle. These were designed to distract children from the drug delivery event
itself and to encourage and reward deep breathing patterns required for effective
delivery of medication. This was a form of operant conditioning that was known
as ‘self-reinforcement’, as correct use of the device rewarded the user, requiring no
external encouragement from a parent or doctor. After this time, parents completed
a matched item questionnaire on the Funhaler to allow direct comparison with
the standard device. Researchers also conducted one random check via telephone,
checking on participant usage of the Funhaler on the previous day.
RESULTS
The survey showed that use of the Funhaler was associated with improved
parental and child compliance. The researchers collected 27–32 valid responses
to each pair of questions being collected. Fifty-nine per cent of parents were
found to have medicated their children on the previous day when using their
standard device compared to 81% when using the Funhaler. Researchers also
found 50% of children took the four or more cycles per aerosol delivery or ‘puffs’
when they used the standard device, compared to 80% achieving this with the
Funhaler. A number of problems when taking medication – such as screaming
when the device was brought close to the child’s face, unwillingness to breathe
through the device, or unwillingness to breathe for a long time – were all
significantly reduced when using the Funhaler. Sixty-eight per cent of children
reported pleasure when using the Funhaler, whereas only 10% enjoyed using the
standard device. Parents also reported improved satisfaction with the device
(see Table 3.2).
look in the book for table
CONCLUSIONS
Chaney et al. conclude that the Funhaler and its use of positive reinforcement
techniques improved levels of medical compliance in young asthmatics.
Specifically they argue:
1 The use of the Funhaler could possibly improve clinical outcomes, such as
lowering rates of admissions to hospital for asthma attacks.
2 Devices that use self-reinforcement strategies can improve the overall health
of children.
EVALUATION - The research method
The study is a field experiment and used controls to try to
manage the influence of extraneous variables on the DV
(which was compliance to medical regime). For example, the
questionnaires used to assess each device contained matched
questions to ensure the children’s’ responses were directly
comparable. However, the study’s findings rely on self-report,
which is open to bias as participants might over-report use of
the Funhaler in order to please the experimenters.
EVALUATION - Qualitative and quantitative data
This study reports quantitative findings given in numerical
form, such as the numbers of asthmatic children and their
parents who administered medication on randomly checked
days. It allowed the researchers to directly and objectively
compare the use of each device. However, they did not report
in this study any verbal or written feedback from children and parents. This lack of qualitative data means they have assumed
and not demonstrated that the operant conditioning device
known as the Funhaler is what encouraged better compliance.
