Construction Of Decision Aid Program For Parental Involvement In Exercise Prescription For School-age Children With Asthma

ObjectiveThis study was guided by the Ottawa decision support framework,based on the shared decision-making model,from the perspective of parents of children with asthma,combined with their values and actual clinical needs,to form a summary of the best evidence for exercise interventions,and to construct a set of scientific,safe and localized decision support program for parents of children with asthma to participate in the development of exercise prescriptions,in order to provide decision support to promote the active participation of parents of children in shared decision-making model and alleviate the level of decision-making conflict,as well as to provide high-quality evidence-based guidance for children with targeted exercise behaviors to improve their symptom control outcomes and quality of life.MethodThis study is divided into three parts,the first part is from the perspective of parents of children with asthma,through a semi-structured interview with 17 parents of school-age children with asthma attending the pediatric respiratory departments of three tertiary hospitals in Jinan,using the Colaizzi seven-step method to collate and refine the barrier factors faced by parents of children in the decision-making process related to exercise prescription and the potential decision-making needs;the second part focuses on the interventions of exercise training and physical exercise for children with asthma,and through systematic search,evaluation and summarization of relevant literature from various guideline websites and databases,the best evidence summary of the current exercise prescription suitable for the group of children with asthma was formulated;In the third part,based on the first two parts of the study,we considered the barriers and needs of decision making as the key points of the decision aid program,and the evidence summary of exercise prescription as the core content of the decision aid program,and sorted out the specific content of the aid in each stage of shared decision making,and constructed a practical,scientific and effective decision aid program for parents to participate in exercise prescription through two rounds of Delphi expert consultation.A practical and scientifically valid decision aid for parental involvement in the development of exercise prescriptions for children with asthma was initially constructed through two rounds of Delphi expert consultation.Result1.Guided by the Ottawa Decision Support Framework,this study analyzed the interview data of 17 parents of school-age children with asthma and extracted three different levels of themes and nine sub-themes:(1)Decision-making needs level:①lack of disease-related knowledge;②limited information acquisition and identification;③uneven willingness to participate in decision-making;④bound by specific family situations;(2)Decision-making support level:①lack of necessary support for decision making;②poor communication between healthcare providers and patients;③ insufficient support from family members;(3)decision quality level:①psychological pressure of decision reversal;② unreasonable decision risk perception.2.In this study,through systematically searching guideline websites and Chinese and English databases such as BMJ Best Practice,UpToDate,Scottish Interhospital Guidelines Network,The Cochrane Library,GINA website,International Guidelines Library,JBI Library,PubMed,Web of Science,China Knowledge Network,Wanfang,etc.The best evidence on the effects of motor training interventions for children with asthma at home and abroad was summarized,and 16 publications were finally included,covering 4 clinical guidelines,2 expert consensus,1 recommended practice,and 9 systematic reviews.The collation could yield a total of 25 evidence entries in 8 areas,and the quality evaluation results of the included literature were all high,which had important reference value for constructing the core content of the decision aid program.3.In the Delphi expert consultation section,16 experts from East,North,South,and Central China were invited to participate in two rounds of consultation,and they made 12 specific suggestions to the first draft of this program.The recovery rate of the two rounds of expert consultation were all 100%respectively,indicating that the experts were highly motivated,the authority coefficient was 0.839,indicating a high degree of authority of the experts,and the importance coordination coefficients of the experts for the first-level indicators and specific items were 0.175 and 0.142 respectively after the two rounds of consultation,indicating a high degree of coordination of the experts’ opinions.The final draft of the decision support program for parental involvement in the development of exercise prescription for school-age asthmatic children was formed after the initial version of the decision support program was revised article by article according to the specific opinions of the experts,with 16 primary indicators and 39 specific items.Conclusion1.The results of this study indicate that some parents of children with asthma have a high willingness to participate in decision-making regarding their children’s exercise prescriptions,but their overall decision-making ability is at a low level due to several barriers factors,which affects their confidence and enthusiasm in decision-making to some extent.In addition,the participants’ lack of necessary decision support,poor communication between healthcare providers and patients,and their own unreasonable perceptions of exercise risks are important hindering factors for their participation in clinical decision-making.2.This study found that few domestic studies have explored the effects of different exercise training modalities on lung function and symptom control effects in children with asthma,as well as the lack of specific programmatic guidance on exercise for children with asthma.In contrast,foreign clinical guidelines or studies are not suitable for direct application to the domestic population of children with asthma due to differences in growth and developmental patterns and perceptions of exercise in children.Therefore,this study extracted important information from the included high-quality literature to supplement the core of the decision aid program related to exercise prescription.3.The decision aid program constructed in this study was formed on the basis of three components:qualitative research,evidence summary,and expert consultation,with a high level of motivation and authority of the consulted experts and a high coordination coefficient of importance of the program content.The program is scientific,comprehensive and practical,and it has certain guidance and significance for promoting the participation of parents of children with asthma in the shared decision making between healthcare providers and patients,helping children with asthma to establish correct beliefs about exercise,and improving their lung function levels and symptom control outcomes.