D - Chaney Flashcards
Aim
- The aim of this study was therefore to show that the use of a novel asthma spacer device, the “Funhaler”, which incorporates incentive toys isolated from the main inspiratory circuit by a valve, whilst not compromising drug delivery, can provide positive reinforcement which leads to improved adherence in young asthmatics.
Background
- Behaviour therapy and behaviour modification (based on classical and operant conditioning) have been major approaches used by both clinical psychologists and health practitioners to improve adherence to prescribed medical regimes.
- Poor adherence to prescribed frequency and technique remains a major problem for paediatric asthmatics on inhaled medication (Chaney et al, 2004).
- Rates of compliance for offering medication regularly to asthmatic children range from 30% to 70%, while paediatric compliance rates for the correct pressurised metered dose inhaler (pMDI) technique range from 39% to 67%. Adherence does not necessarily improve with rising severity of illness (Chaney et al, 2004).
- Although reasons for poor adherence are varied, Watt et al proposed that a positive interplay of adherence considerations with aerosol output factors would improve medication adherence in young asthmatics.
Method
- This was a field experiment, conducted in the participants’ home settings in Australia, which used a repeated measures design.
- The independent variables (IVs) were:
(i) whether the child used a standard/small volume spacer device – the Breath-a-Tech (Scott-Dibben, Australia)
(ii) whether the child used a Funhaler (InfMed Ltd, Australia). - The dependent variable (DV) was the amount of adherence to the prescribed medical regime.
Sample
- 32 children (22 male, 10 female; age range 1.5 - 6 years, median and mean age 3.2 years; average duration of asthma 2.2 years) prescribed drugs delivered by pMDI and spacer were recruited.
- The children’s parents provided informed consent and also participated in the study through completing questionnaires and taking part in a phone interview. They also helped (where necessary) in the use of the inhalers.
Procedure
- Firstly, a comparison was made between the aerosol output of the standard/small volume spacer device (235ml Breath-a-Tech) and the 225ml Funhaler. Overall no significant differences were observed. The comparison was therefore complementary, indicating that the use of a Funhaler rather than a standard inhaler does not compromise drug delivery.
- As part of this process, participants were approached by the researcher at home initially before the Funhaler was mentioned and were interviewed with a questionnaire on their existing use of the inhaler.
- Then they were give the Funhaler for two weeks and reported over the phone on an ad hoc basis to take snapshots of whether they had used the Funhaler the previous day.
- Matched questionnaires were competed (by parents) after sequential use of the Breath-a-Tech inhaler and the Funhaler.
- After sequential use of the Breath-a-Tech inhaler and the Funhaler they were then visited again by the researcher and parents were interviewed and completed the matched questionnaires.
- Data collected from the self-report related to how easy each device was to use, compliance of parents and children, and treatment attitudes. Furthermore, during the course of the study each parent was called at random to find out whether they had attempted to medicate their child the day before.
- The Funhaler incorporates a number of features to distract the attention of children from the drug delivery event itself and to provide a means of self reinforcing the use of effective technique. The Funhaler makes spacers appealing to children in the following ways:
(i) It isolates incentive toys (eg spinner and whistle) in a separate branch to the standard inhalation circuit, placing them outside the expiratory valve of the spacer to avoid problems of contamination and interference of drug delivery.
(ii) The design of the toys themselves ensures sufficient inspiratory resistance to minimise entrainment of inspired air through the toy circuit.
(iii) The design attempts to link the optimal function of the toys to deep breathing pattern conducive to effective medication.
(iv) The design anticipates the potential for boredom of children with particular incentive toys in its modular arrangement which would allow the replacement of the incentive toy module with a range of different toys.
Results
- The use of the Funhaler was associated with improved parental and child compliance.
- When surveyed at random, 81% (22/27) of children using the Funhaler were found to have been medicated the previous day compared to 59% of children (16/27) using the existing small volume spacer device.
- 30% more children took the recommended four or more cycles per aerosol delivery (24/30 – 80% versus 15/30 – 50%; p = 0.02) when using the Funhaler compared with the standard/small volume spacer.
- When using the standard/small volume spacer only 3/30 parents reported being always successful in medicating their children compared to 22/30 when using the Funhaler (p≤0.001).
- Of the parents who were unsuccessful with the conventional spacer, 17 became successful with time and practice in medicating their children, leaving 11 who never succeeded. When these 11 were changed to the Funhaler, 7 were immediately successful, 1 became successful with time and only 3 continued to have problems.
- Use of the Funhaler was associated with fewer problems than when using the existing device.
Conclusions
- Improved adherence, combined with satisfactory delivery characteristics, suggest that the Funhaler may be useful for management of young asthmatics.
- The use of the Funaler could possibly be translated to improved measures of clinical outcome.
- The use of functional incentive devices such as the Funhaler may improve the health of children.
- More research is recommended in the long-term efficacy of this treatment.
Method Evaluation
P This study used a field experiment and therefore it is high in ecological validity.
E As participants remain in their natural environment for field experiments the behaviours they exhibit are more likely to reflect those found in a real life setting and therefore findings are more generalisable.
E In the Chaney study participants took both the standard and the fun inhaler in their own home as previously prescribed. This means that the taking of the medication and the impact of the positive reinforcement can be generalised to real life settings.
P However, field experiments lack in control and therefore internal validity can be low.
E In field experiments participants are in their natural environment and therefore there is a lack of control over the environment. This may mean that extraneous variables, changes in the environment that are not meaning to be measured can impact the results.
E In Chaney participants administered the standard and Funhaler in their own homes and therefore it cannot be clear whether the increase in taking of the medication was due to the incorporation of positive reinforcement or whether an environmental factor such as a change in the weather, increased exercise caused the participants to take more medication.
Data
P A strength of quantitative data is that it is high in reliability.
E Numeric data is objective in its analysis, this means that it will not be affected by the thoughts, opinions or experiences of the researcher and therefore another researcher can repeat the analysis and gain the same results.
E In the Chaney study the researcher simply counted how many participants gave each response to the closed questions asked in the telephone interviews regarding whether medication had been successfully given the previous day and the responses in the close question questionnaires.
P A weakness of quantitative data is that it can be said to be low in internal validity
E As numeric data is limited in its detail it can often be unclear why the researchers got the results they did, as we are unable to see the full picture. Therefore, it can be hard to draw conclusions, as we cannot be sure that the IV causes the change in the DV.
E In Chaney we can see that the adherence to asthmatic medication increased when the fun inhaler was introduced but we cannot be sure that it was the positive reinforcement that caused this without qualitative data. For example the increase could have been caused by a change in the weather or increased exercise causing more symptoms and need to take the inhaler
Ethics
P On ethical guideline that researchers should abide be is protection from harm.
E The British Psychology Society (BPS) sets the ethical (moral) guidelines that researchers should always try to abide by. Researchers should always try to avoid harming their participants emotionally, physically and psychologically.
E In Chaney the researcher ensured that all participants were protected by ensuring that the Funhaler did not cause a change in the amount of asthmatic medication administered.
Reliability
P A strength of the Chaney study is that it is high in external reliability.
E The procedure was standardised meaning that a number of controls have been put in place to ensure that all participants had a similar experience. Therefore, another researcher should be able to repeat the study and receive the same results.
E In Chaney they used standardised questions when collecting data via interview and questionnaires regarding the adherence of asthmatic medication and attitudes towards the standard and Funhaler.
A
P A weakness of the Chaney study is that it is low in external reliability.
E The procedure is not fully standardised and therefore there may have been differences between participants. This would make it vary hard to repeat the study exactly and gain the same results.
E In Chaney’s study participants were in the comfort of their own home and therefore may have had different routines and encouragement when it came to the taking of the medication and this could of changed between using the standard and fun inhaler.
Validity
P A strength of the Chaney study is that it is high in internal validity.
E A number of controls have been put in place to ensure that extraneous variables do not impact the DV and therefore helping to ensure cause and effect can be established (suggesting the IV causes the DV)
E Chaney used a repeated measures design meaning that participants who were in the standard inhaler condition were also in the fun inhaler condition. This eliminates individual differences from having an impact on the DV e.g. the severity of the asthma being the reason for the differences in the taking of the medication rather than the change of the inhaler.
P A weakness of the Chaney study is that it can be said to be low in internal validity.
E Although a number of controls have been put in place not all extraneous variables have been controlled for and therefore they may not have been measuring the impact of the IV on the DV.
E In Chaney they used self-report to assess whether medication had been administered and the parents and childs attitudes towards the fun and standard inhaler, demand characteristics could have caused inaccurate results. The participants may report more positively of the fun inhaler as they believe this is what the researcher would like to hear.
Sampling Bias
Just Children
Ethnocentrism
Perth
