OBJECTIVES: Asthma is a controllable chronic condition when patients engage self-management behaviors. Adolescents are in a developmentally critical time for adopting outcomes-impacting self-management habits. Motivational interviewing (MI) is a behavior change intervention demonstrating impact in adolescents with other conditions. The objective of this study was to conduct a systematic review to explore and report evidence and gaps in literature including MI intervention in adolescents with asthma.
METHODS: A modified Cochrane method of search and review was conducted among relevant databases (e.g., MEDLINE, PsychInfo, CINAHL, Cochrane). Inclusion criteria included experimental designs with pre/post data collection, published in English before December 1, 2019, and evaluating interventions that included MI for impact on asthma outcomes in adolescents. Two review tiers were conducted (title/abstract and full text), and reference lists hand searched. Methodological quality assessment used Joanna Briggs Institute tools per study design.
RESULTS: Of 165 initial publications, five were retained for the final review. Adolescents in retained studies (ages 9–18) were mostly from African American or Hispanic population segments (4/5 studies); and 4/5 studies were conducted in real world settings. All five used face-to-face MI interactions; 2/5 added telephone contacts. The MI was used with asthma education, direct observation therapy, and problem-solving skills training. Four of five studies demonstrated impact of interventions; outcomes included asthma symptoms, school days missed, motivation level, medication adherence, general self-management. All five measured quality of life. Study methods and measures varied significantly; methodological quality assessments generated moderate results, difficult to compare due to heterogeneity.
CONCLUSIONS: This literature exploration found that most (4/5) studies of MI in adolescents with asthma were conducted among minority adolescents, and most (4/5 studies) demonstrated that MI is feasible and effective for inclusion in asthma self-management interventions in real world settings. Evidence gaps: no studies examined economic/utilization outcomes and more studies are needed.
