Spirometry and Puerto Rican Children - Research Proposal Example

Spirometry and Puerto Rican Children Introduction Asthma is a chronic disease characterized by breathlessness and wheezing (WHO, . The severity and frequency of the attack may vary from person to person and its symptoms may affect the person several times for a day or even for weeks (WHO, 2011). Although asthma has low mortality rate compare with other chronic diseases, the burden of asthma continue to increase afflicting persons regardless of age and gender, affecting countries irrespective of development (CDC, 2011). In this condition, asthma continues to be a serious public health problem (www.epa.gov). In the United States, 10 million children aged 17 years old and below, are diagnosed with asthma and that 7 million are still suffering from the disease (CDC, 2011). What makes matter worst, is the fact that asthma is considered as one of the most common chronic diseases among children and it is the third –ranked cause of hospitalization among children aged 15 and below (www.epa.gov). In addition, asthma among children causes 10.5 million days of school missed each year (www.epa.gov). Furthermore, Puerto Rican children have the highest prevalence rate of active asthma (11%) among Hispanic children. In this condition, Puerto Ricans have higher asthma prevalence and morbidity compared with whites, blacks, and other Hispanic sub-groups (Cohen 1331). In fact, in current study, the rate of asthma among Puerto Ricans is 113% higher than non-Hispanic white people and 50% higher than non-Hispanic black people (www.epa.gov). In the face of this perilous situation, there is an urgency to address the needs and health condition of the Puerto Ricans suffering from asthma. Since, there is a continued increase in asthma prevalence and morbidity among Puerto Ricans despite the continued effort of controlling and curbing the impact of asthma in the lives of Puerto Ricans afflicted with the chronic disease. This research intends to establish a paradigm that will address acute asthma attack, but at the same time, formulate an educational program that will address the long-term care management of asthma – spirometry as an integral part of the management of asthma care for Puerto Rican children suffering from asthma. Problem Statement Breathing easier is supposed to be effortless and a voluntary physical activity that is an integral part of human existence. However, for people suffering from asthma, breathing becomes a difficulty, a disease and condition that limits their activities and significantly reduces their quality of life while being exposed to an increasing risk of death (Bartolomei 2008; Ortega et al. 2002). Puerto Rican children in particular and Puerto Ricans in general have the highest prevalence of active asthma and morbidity among Hispanics (Flores 2002). Despite the fact that experience of poverty and other social- and environmental factors such as exposure to higher indoor and outdoor air pollutants, hazardous waste sites, pesticides, lead and mercury are prevalent among other Hispanic sub-groups like Mexicans, Dominicans and Cubans (Flores 2002). In this condition, wherein asthma prevalence continue to increase and asthma burden persists contributing to reduce productivity and missed school days, it becomes urgent to develop programs that will address concerns pertinent to acute attacks and long term care management of asthmatic children. This is essential in order to check the dwindling quality of life not only of the children who are having difficulty in breathing, but also of desperate parents struggling with their children’s disease. As such, this study intends to come up with a paradigm that will address concerns regarding asthma acute attacks and lay down an educational program that is feasible and authentically geared towards responding to the demands of Puerto Rican children with asthma. At the same time, it seeks to bridge the gap in the literature (Flores 2002). Since, it has been observed that Latinos, in general, are not properly represented in clinical studies and that most literatures dealing with Latinos health condition and disparity are homogenous and fails to recognize the diversity of Hispanic groups (Flores 2002). Although, it has been observed that when it comes to asthma issues, there appears to be a segregation of Hispanic groups in the collected data, however, it still fails to identify the definitive social and environmental factors that contribute to the high prevalence of active asthma among Puerto Ricans (Flores 2002). In this regard, as there is a necessity to come up with programs and policies that will both address the issues of acute asthma attacks and long-term care management of asthma; the research asserts the notion that lung functions measurement, which are integral part of the diagnosis and treatment of asthma, be integrated in the treatment of acute asthma attacks and be incorporated in the education and long-term care management of asthma patients. Research Questions In view of the gravity of the issue of asthma among Puerto Ricans, this research will be addressing three main questions 1. How can spirometry control and curb acute asthma attacks among Puerto Rican children? 2. How can spirometry be incorporated in the in the long-term care management of asthma among Puerto Rican children? 3. How can spirometry be included in the education and management of asthma among Puerto Rican children? To further, clarify these three questions, the study will answer the following sub-questions. (i) What are the identified factors that contribute to the high prevalence and morbidity of asthma among Puerto Rican children? (ii) Does poverty increase the risk of asthma? (iii) What is the current trend and issues regarding the use of spirometry in asthma? (iv) What are the perceived advantages and disadvantages in the use of spirometry during acute asthma attacks? (v) What are the potential benefits that can be gained with the integration of spirometry in long-term care management of asthma? (vi) What are the possible weaknesses in integrating spirometry in the long-term care management of asthma? Observable in the questions is the notion that the study will focus only on several significant elements. These are asthma, Puerto Rican children, acute attacks, long- term care management, factors affecting asthma of Puerto Rican children and spirometry. In this context, some policies and programs may be alluded in the course of the discussion of the subject matter of the study, but it will only be in aide for the clarification of the study. Hypothesis Hypothesis 1 Spirometry can be an effective tool in controlling and curbing acute asthma attacks among Puerto Rican children. Hypothesis 1a Spirometry cannot be an effective tool in controlling and curbing acute asthma attacks among Puerto Rican children. Hypothesis 2 Spirometry can be used in the long-term care management of asthma among Puerto Rican Children. Hypothesis 2a Spirometry cannot be used in the long-term care management of asthma among Puerto Rican Children. Hypothesis 3 Spirometry’s incorporation in the education and management of asthma is necessary. Hypothesis 3a Spirometry’s incorporation in the education and management of asthma is necessary. Objectives of the Study The following are the aims of the research. 1. To gain better understanding of the factors affecting the continued high prevalence of active asthma and morbidity of asthma among Puerto Rican children 2. To identify the advantages and disadvantages of spirometry in controlling and curbing acute asthma attacks. 3. To determine ways for spirometry to be incorporated in the long term care management of asthma. 4. To develop policies and programs wherein spirometry plays a significant role 5. To bridge the gap in the literature regarding asthma and Puerto Rican Children 6. To work out a paradigm that is authentically responsive to the needs and demands of Puerto Rican children who are suffering from asthma. Literature Review Asthma is a chronic condition that affects people at any age. Caring and educating patients and family members is a challenge. Since the symptoms do have, a profound impact not limited to the patient but to the family as well. In this regard, the literature review will center on three important points asthma and Puerto Rican children, some models of health promotion and disease prevention and current debate pertinent to use of spirometry among asthma patients. In view of this, the literature review will be having three parts. The first part will be dealing with asthma and Puerto Rican children. This is necessary, as it will provide the context and condition, which study is trying to address. Meanwhile, the second part will deal with Nora Pender’s model of health promotion and Elizabeth Lenz’s Theory of Unpleasant Symptoms (TOUS). These theories are significant as it sheds light to the necessity of education in the care and management of chronic disease such as asthma. Finally, the last section will be dealing with the current issues of spirometry in asthma. This section will inform about the current debates regarding the effectiveness of spirometry in controlling acute asthma and its long-term care management. In the end of the literature review, a summary of the discourse will be given. Asthma and Puerto Rican Children In Puerto Rico (PR), asthma is considered as one of the most serious problems in public health. The morbidity and mortality from asthma are higher in comparison with the United States. Puerto Rican children are nearly 300 percent more likely to have the respiratory ailment than white non-Hispanic children in the continental United States. The island, with a population of 4 million, already has 2.5 times the death rate stemming from asthma as the mainland, according to the U.S. Centers for Disease Control and Prevention. Puerto Ricans in the U.S. also have been hit hard by asthma, with an asthma attack rate 2.5 times higher than for whites (CDC 2011). Cohen et al (2007) in study have found out that Puerto Rican children in the United States have high prevalence of active asthma compared with other Hispanic sub-groups in the US. This study confirms what has been repeatedly found out in other studies (e.g. Bartolomei 2008; CDC 2011; Flores et al. 2002; Zambrana & Logie 2000). However, they have also found out that Puerto Ricans children who are born in the island suffer an increase risk in asthma prevalence compared with Puerto Ricans born in mainland US. They have stipulated that birthplace and environment play a significant role in their findings while genetics does not seem to have a manifest contribution in intergeneration occurrence of asthma. Almost in the same time tone, Canino et al (2009) have found out that several factors should be considered with the continued high prevalence of active asthma among Puerto Rican children. They maintain that important issues such as poverty, social factors, environmental factors, family factors, health access and behaviors all contribute to the continued prevalence of asthma among Puerto Ricans. What worsens the situation is the fact that because of their socio-economic status, they have limited health access, thus, aggravating their situation. This condition had long been complained about by Zambrana & Logie (2000). They asserted that sufficient measures that required additional funding should be initiated by the government in order to encourage the Hispanics who were incapacitated to be enrolled in any health insurance to enroll in health insurance (pp. 1829-1830). Moreover, they maintained that poverty contributed to the aggravation of asthma concerns, and as such, it should be addressed. Thus, they concluded that Latinos should be consciously included in the health agenda of the government. In addition, the situation is further complicated by the fact that asthma is costing the economy in terms of lost productivity, missed school days and government expenditures, as such; the need to educate patients and care-providers becomes more necessary. This is not only to empower the patient but also to improve their quality of life by helping them gain control of their asthma. Asthma and Education Educating the patient will not only make them aware of the necessary management that they have to know in order to control their asthma, but it also informs them of the context, factors and elements that contribute to the exacerbation of their asthma attacks. This knowledge empowers the patient and helps the care-provider to come-up with the appropriate care-plan that best suits the individual needs of the patient. However, there are several models of health promotion. Thus, several approaches can be developed in order to respond authentically to the actual needs of asthmatic Puerto Rican children. Pender (1997) developed the health promotion model (HPM). The model recognized the fact that addressing health concerns does not begin at the onset of the chronic disease, but that it should start at the time when the patient was still healthy. In this way, the focus of health promotion is prevention of disease, which extends and increases the number of years wherein the patient enjoys quality of life and decreasing years of disability. HPM involved five key important elements – person, environment, nursing, health and illness. The person is the biophysical being that is both affected by one’s inherent genetic make-up and the environment. The individual, on the other hand, creates the necessary environment conducive for human development and pursuit. In this sense, there is a symbiotic relationship between the person and the environment. As such, environment encompasses wise range of facets – economic, social, cultural, and physical environment. Meanwhile, nursing acts as the conduit among the patients, families, and communities as collaborative efforts are undertaken in order to establish the most appropriate conditions that will develop optimal health for everybody. In this way, health becomes a goal that ought to be achieved in order to gain quality life while illness becomes a hindrance in the pursuit of a healthy life. On the other hand, Lenz et al (1997) theory of unpleasant symptoms (TOUS) seeks to integrate the dimensions of symptoms, whether individual or multiple, the implementation of similar interventions may be effective in alleviating one or more symptoms. It is an explanatory theory that aims to explain the complexity and interactive nature of experiencing a symptom and or symptoms. The symptoms experienced by the individual, the influencing factors and the consequences of the symptom experience. The theory provides the opportunities to measure the symptoms presented either separately or in combination with other symptoms since several dimensions are present. The three factors (the symptoms, the influencing factors and the consequences) all relate to one another; they interact and overlap. Physiologic (trauma, pathophysiology), Psychological (anxiety or depression) and situational which can be divided by two components: environmental influencing factors (living conditions that can affect their symptom presentation) and social influencing factors (employment, social: status, support, marital status, access to health care can also interact with one another in their relation to a/or symptom. The effects or consequences a symptom may produce consequences these may be functional consequences (physical, activities of daily living, social interactions, role performance) and cognitive (problem solving, thinking, and concentration). As such, the education of both the patient and the care-provider becomes critical not only for treatment, but in optimizing quality of life in the context of the patient’s asthma. Asthma and Spirometry Debate Lung function measurement is critical in knowing the severity of the asthma attack. Spirometry is a significant tool in the assessment of ling function in both clinical and research set-up. In fact, it is considered as the ‘golden standard’ in which to measure the lung function (Mortimer et al. 2003). However, since spirometer is expensive, portable spirometer acts as a substitute for home spirometry. This situation has opened robust debate regarding the efficacy of spirometry in home care management of asthma for children. Currently, scholars have taken two divergent positions. Linares et al (2006) and Mortimer et al (2003) both affirms the position that home spirometry offers a positive approach in collection of the necessary data to better understand the lung function of children during everyday activities. The results of home spirometry are comparable with that of office spirometry and by far, better than peak flow meters. Linares et al (2006) have found out that spirometry is a feasible and efficient test in preschool and schoolchildren if the standardization requirements are suited to each population. While, Mortimer et al (2003) have conducted a cohort study among 92 children with asthma and concluded their study with the beneficial gains from spirometry. On the other hand, Wensly and Silverman (2001) conducted a research intending to know the quality of the results of portable spirometry among ninety children with asthma aged 7 - 11. They found out that there “was a steady reduction of valid data over the four periods with wide individual differences. Even under ideal conditions, home spirometry provides an incomplete (and therefore potentially biased) picture of long term changes in pulmonary function” (p. 183). Meanwhile, the study conducted by Brouwer et al (2006) attested that spirometry does not provide significant contribution in the reduction of acute asthma attacks among children. Conducting the 3-month study among 36 children, they observed, “using an electronic home spirometer in self-management of childhood asthma does not appear to be useful in improving asthma control (Brouwer et al. 2006, p 1136). Thus, they inferred that spirometer cannot provide substantial difference in the long-term management of asthma. Summary Asthma is a chronic condition requiring the collaboration of the patients, families, communities, government and nursing. It necessitates the understanding of the various factors that affect the patient, which may be perceived as the symptoms of the disease. The current condition of asthmatic Puerto Rican children calls for drastic response. However, the inclusion of spirometry in the long- term management and treatment asthma is still being debated by the scholars. Since, current studies regarding this issue have resulted into differentiated results. Methodology In order to address the questions raise by the research, the researcher will be conducting a quantitative research method. Gay and Airasian (2000), state that quantitative data “are used to describe current conditions, investigate relationships, and study cause-effect phenomena” (p. 11). Quantitative research entails the pre-selecting of variables from where conclusion will be drawn (Sandelowski 2000). Under this kind of research, the phenomenon is considered external and independent to the researcher (Saunders et al, 2007). As such, it is claimed that focus is the phenomenon as the search delves on the possible causal connections and fundamental laws connecting the events (Cohen 1988). This type of research is highly structured and that it can be replicated and renders itself to statistical analysis (Howe & Eisenhart 1990). Thus, the advantages of this methodology are it is value-free, it can be replicated, it can be statistically analyzed and that it uses graphs and other numerical representations rendering the study objective. On the other hand, the perceive weakness of this methodology, value –free is an illusion as researcher always approach their questions from a particular framework and conditioning (Kuhn 1962). As such, the researcher is constantly interpreting the events as they unfold and offers an analysis not removed or external from the reality being observed (Patton 2002). Nonetheless, despite, its weakness, quantitative research method affords an approach towards a better understanding of issues relevant to human existence (Golafshani 2003). Independent Variables For this study, the independent variables include age, gender, social conditions, level of education of parents, and income of the family. These variables are considered as categorical, since, the variables are on nominal scales and are not ranked ordered. Dependent Variables For the research, the dependent variables include frequency of visits to the hospital, frequency of use of spirometer, frequency of attacks, severity of asthma attacks and use of public assistance within the last year. These variables are considered as continuous since they are in ordinal scale and that it is assumed that the larger the measurement, the higher the value. Participants For this research, using questionnaires, the primary data will be collected from asthmatic Puerto Rican children with an age range of 6 – 12. This can be further divided into groups. The first group are children between 6 – 8 years of age and the second group is between 9 -12. The rationale behind the division is for easier management of data and to be able to clearly note possible observable patterns within the group and when the two groups will be compared. Data Analysis For the analysis of the collected data, two-way ANOVA will be used. The researcher believes that this approach will be useful since it allows for multiple levels of observations on different factors. This is advantageous because it is more efficient, it allows for testing the effects of two factors at the same time. Finally, it is advantageous because it can test the independence of the factors (Cohen 1988). References: Bartolomei J. 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