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Developmental Psychology External influences on children’s behaviour – Chaney, Clements, Landau, Bulsara and Watt CHANEY, G., CLEMENTS, B., LANDAU, L., BULSARA, M. and WATT, P. (2004) A new asthma spacer device to improve compliance in children: a pilot study. Respirology, 9, (4) 499-506. 5. Outline of the procedure/study • 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. 32 © OCR 2017
Developmental Psychology External influences on children’s behaviour – Chaney, Clements, Landau, Bulsara and Watt CHANEY, G., CLEMENTS, B., LANDAU, L., BULSARA, M. and WATT, P. (2004) A new asthma spacer device to improve compliance in children: a pilot study. Respirology, 9, (4) 499-506. 6. Key findings • 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. 7. Possible 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. 33 © OCR 2017
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