Asthma case management and education programs improve pediatric asthma outcomes, but designing rigorous randomized controlled studies that accurately measure effects while encouraging parent participation is challenging. This is especially so for low-income African American families, who face significantly more severe asthma and social stress than their middle-class counterparts. Action research can help health education researchers negotiate between the elegant and complex designs favored by scientists with the real-life challenges of recruitment, implementation, and retention. This article discusses how a multidisciplinary team uses action research concepts to continuously adjust originally proposed protocols through the planning and implementation phases to encourage participation in a year-long randomized controlled trial of a program that combines telephone asthma case management and comprehensive online asthma education. As a result of these efforts, a higher proportion of low-income African American families are recruited into the study than originally proposed.
Andrew, A., Auinger, P., Byrd, R., & Weitzman, M. ( 2000). Risk factors for pediatric asthma: Contributions of poverty, race, and urban residence. American Journal of Respiratory and Critical Care Medicine, 162(3), 873-877.
2.
Argyris, C., & Schön, D.A. (1989). Participatory action research and action science compared: A commentary. The American Behavioral Scientist, 32(5), 612-623.
3.
Bauman, L.J., Wright, E., Leickly, F.E., Crain, E., Kruszon-Moran, D., Wade, S.L., et al. (2002). Relationship of adherence to pediatric asthma morbidity among inner-city children. Pediatrics, 110(1), 1-7.
4.
Bender, B., Milgrom, H., & Apter, A. ( 2003). Adherence intervention research: What have we learned and what do we do next? Journal of Allergy and Clinical Immunology , 112(3), 489-494.
5.
Bonner, S., Zimmerman, B., Evans, D., Irigoyen, M., Resnick, D., & Mellins, R. ( 2002). An individualized intervention to improve asthma management among urban Latino and African-American families. Journal of Asthma, 39(2), 167179.
6.
Brydon-Miller, M., Maguire, P., & Greenwood, D. ( 2003). Why action research? Action Research , 1(1), 9-28.
7.
Centers for Disease Control and Prevention. ( 2006). Access to health care, financial structural, and personal barriers. In Healthy People 2010: Understanding and improving health. Washington, DC: Government Printing Office.
8.
Deming, W.E. ( 1982). Out of the crisis: Quality, productivity and competitive position. Cambridge, UK: Cambridge University Press.
9.
Dey, A., Schiller, J., & Tai, D. ( 2004). Summary health statistics for U.S. children: National Health Interview Survey, 2002. Vital Health Statistics, 10(221), 1-78.
10.
Gross, D., Julion, W., & Fogg, L. ( 2001). What motivates participation and dropout among low-income urban families of color in a prevention intervention? Family Relations, 50(3), 246-254.
11.
Gustafson, D., Johnson, P., Molfenter, T., Patton, T., Shaw, B., & Owens, B. ( 2001). Development and test of a model to predict adherence to a medical regimen. Journal of Pharmacy Technology, 17, 198-208.
12.
Gustafson, D., Wise, M., Meis, T., Molfenter, T., Staresinic, A., Sorkness, C. et al. (2004). Improving medication adherence through decision theory and the Internet. In J. Dunbar-Jacobs , J. Erlen, E. Schlenk, & C. Stilley (Eds.), Methodological issues in the study of adherence (pages 95-106). Pittsburgh : University of Pittsburgh School of Nursing.
13.
Juniper, E., Guyatt, D., Feeny, P., Ferrie, L., Griffith, L.E., & Townsend, M. ( 1996). Measuring quality of life in parents of children with asthma. Quality of Life Research, 5, 27-34.
14.
Lemaigre, V., Van den Bergh, O., Van Hasselt, K., De Peuter, S., Victoir, A., & Verleden, G. ( 2005). Understanding participation in an asthma self-management program. Chest, 128(5), 3133-3139.
15.
Mansour, M.E., Lanphear, B.P., & DeWitt, T.G. (2000). Barriers to asthma care in urban children: Parent perspectives. Pediatrics, 106, 512-519.
16.
Masters, J. ( 1995). The history of action research. In I. Hughes (Ed.), Action research electronic reader. Sydney, Australia: University of Sydney. Retrieved August 7, 2008, from http://www.scu.edu.au/schools/gcm/ar/arr/arow/rmasters.html
17.
Moen, R.D., Nolan, T.W., & Provost, L.P. ( 1999). Quality improvement through planned experimentation. New York: McGraw-Hill.
18.
National Asthma Education and Prevention Program. ( 1997). Expert panel report: Guidelines for the diagnosis and management of asthma. Bethesda, MD: USDHHS, National Heart, Lung and Blood Institute.
19.
Patterson, M., Jennifer, M., Medves, J.M., Chapman, C., Verma, S., Broers, T., et al. (2007). Action research as a qualitative research approach in inter-professional education: The QUIPPED approach. The Qualitative Report, 12(2), 332-344.
20.
Percy-Smith, B. ( 2007). "You think you know? . . . You have no idea": Youth participation in health policy development. Health Education Research, 22(6), 879-889.
21.
Riekert, K.A., & Rand, C.S. ( 2002). Electronic monitoring of medication adherence: When is high-tech best? Journal of Clinical Psychology in Medical Settings, 9(1), 25-34.
22.
Schulte, A., Musolf, J., Meurer, J.R., Cohn, J.H., & Kelly, K.J. ( 2004). Pediatric asthma case management: A review of evidence and an experimental study design. Journal of Pediatric Nursing , 19(4), 304-310.
23.
Stringer, E., Guhathakurta, M., Masaigana, M., & Waddell, S. ( 2008). Guest editors’ commentary: Action research and development. Action Research, 6(2), 123-128.
24.
U.S. Census Bureau. (2000). 2000 Census. Retrieved August 7, 2008, from www.census.gov
25.
Wang, M., Mannan, H., Poston, D., Turnbull, A.P., & Summers, J.A. ( 2004). Parents’ perceptions of advocacy activities and their impact on family quality of life. Research and Practice for Persons With Severe Disabilities, 29(2), 144-155.
26.
Wisconsin Department of Health and Family Services. ( 2004). Burden of asthma in Wisconsin. Retrieved August 7, 2008, from http://dhfs.wisconsin.gov/eh/asthma/pdf/boawi04.pdf
27.
Wisconsin Department of Health and Family Services. ( 2004a). Burden of asthma in Wisconsin. Retrieved August 7, 2008, from http://dhfs.wisconsin.gov/eh/asthma/pdf/boawi04.pdf
28.
Wise, M., Gustafson, D., Sorkness, C., Molfenter, T., Staresinic, A., Meis, T., et al. (2007). Internet telehealth for pediatric asthma case management: Developing integrated computerized and case manager for tailoring a web-based asthma education program. Health Promotion Practice , 8(3), 282-291.
29.
Wolf, F.M., Guevara, J.P., Grum, C.M., Clark, N.M., & Cates, C.J. ( 2002). Educational interventions for asthma in children. Cochrane Database of Systematic Reviews, 4(3), Art. No.: CD000326. DOI: 10.1002/14651858.CD000326.
