Asthma in life context: Video Intervention/Prevention assessment (VIA)

Objective. Video Intervention/Prevention Assessment (VIA) was developed to determine whether medical information gathering might be augmented by video diaries created by patients to show clinicians the realities of managing c hronic disease in the contexts of their lives. Design. Children and adolescents who met National Heart, Lung, and Blood In stitute criteria for moderate or severe asthma were enrolled from an urban pediatric hospital and an inner-city health center. Comprehensive, asthma-s pecific medical histories were obtained from study participants in standard clinical interviews. Participants were trained to use video camcorders and recorded visual narratives of how they lived with and managed their asthma over a 4- to 8-week period. These visual narratives were screened by a tra ined observer, who completed the initial comprehensive medical history base d solely on viewing the video. Information from participants' medical histo ry interviews was compared with observations of their visual narratives. Results. Twenty young people 8 to 25 years old completed the VIA Asthma stu dy. Important variations were found between participants' medical history i nterviews and their visual narratives. All 20 participants reported specifi c environmental triggers for their asthma; 19 had 1 or more of these trigge rs documented on video in their daily living environments (video illustrati ons online, available at: www.pediatrics.org). Exposures to known triggers ranged from 25% (noxious fumes) to 91% (mold). Exposure to tobacco smoke th at was denied in the interview was revealed on video in 63%. The 18 partici pants who revealed medication use in their visual narratives were assessed for adherence: 33% exceeded prescribed doses, 28% discontinued medications without consulting a clinician, and 72% used ineffective inhaler technique. Conclusions. VIA visual narratives extended a comprehensive, standard of ca re medical history, yielding a more complete and accurate understanding of exacerbating environmental exposures and inappropriate medication usage of children and adolescents with asthma. VIA is an effective tool for revealin g the physical and psychosocial environments in which young people live wit h disease. Patient-created video can enrich our understanding of the illnes s experiences of children and adolescents. VIA has the potential to enhance clinical data gathering, guide the development of more effective and sensi tive management strategies, and educate clinicians about the realities of t he young person living with illness.