Elsevier

Journal of Adolescent Health

Volume 27, Issue 3, September 2000, Pages 155-165
Journal of Adolescent Health

Adolescent health briefs
Video intervention/prevention assessment: a patient-centered methodology for understanding the adolescent illness experience1

https://doi.org/10.1016/S1054-139X(00)00114-2Get rights and content

Abstract

Objective: To better understand the issues and needs of adolescents with chronic health conditions, the Video Intervention/Prevention Assessment (VIA) integrates video technology with qualitative research methods to obtain a patient-centered perspective on illness and health care.

Methods: Young people with chronic disease are interviewed for condition-specific verbal reports (CSVRs) of their medical and psychosocial histories. Standardized health-related quality of life (HRQL) instruments are administered. Trained to use video camcorders, participants record visual narratives of their illness experiences. They document their daily lives, interview families and friends, and record personal monologues regarding their observations, behaviors, understandings, and beliefs about their disease. On completion of the visual narratives, HRQL is again evaluated. Verbal, scaled, and visual data are analyzed from three perspectives: medical, psychosocial, and anthropological. Data from the CSVRs, HRQLs, and visual narratives are triangulated to validate and enrich findings.

Results: Investigating the illness experience from the adolescent patient’s perspective, the VIA method was pilot-tested with children and adolescents with asthma. As a research tool, VIA found environmental risk factors, medication adherence problems, and outcome-affecting illness beliefs and psychological states that were not identified by standard clinical tools. As an intervention, VIA showed that it may be an effective tool for health-related environmental surveys. Participants’ condition-specific quality of life showed measurable improvement after the self-examination process of VIA. As communication, VIA made apparently counterproductive patient behaviors understandable by showing them in context with the adolescent’s experience of illness and health care. VIA can enhance medical history-taking and management strategies, improve adolescents’ self-management skills, and educate clinicians, families, and students of the health care professions about the realities of the adolescent living with a chronic health condition.

Section snippets

Sample selection

In qualitative inquiry that investigates small populations in great detail, it is critical to work with research participants who most accurately represent the population being studied. This issue is addressed by selecting exemplars (13), individuals in whom observable phenomena represent the general phenomena of investigative interest. Applying this concept to health research with VIA, we recruit exemplars who meet clinical diagnostic criteria and represent the diversity of gender, race,

Results

Results from the VIA–Asthma pilot, portions of which have been reported elsewhere 17, 43, 44, were rich and varied. The video documentation of participants’ day-to-day lives and environments yielded different and more detailed data than had the medical histories. A majority of the home and neighborhood tours done for the pilot study showed asthma triggers that were specifically asked about in the CSVR interview but not acknowledged by the participants (43). Exposures to dust, mold,

Applications

Results of the VIA pilot study indicated three areas in which to implement the VIA methodology: as research tool, as clinical intervention, and as patient-centered communication.

Conclusion

Providing a unique patient-centered view of the world of adolescents and their experience of illness, VIA can be an effective means of expanding our knowledge of disease beyond the clinical setting. In a sense, it uses contemporary communications technology and methods of qualitative inquiry to return to the traditional house call. The illness narratives that the young people who live with asthma produced yield a body of important information about this disease that could not have been obtained

Acknowledgements

This research was presented in part on March 5, 1998, at the Society for Adolescent Medicine (SAM) meeting in Atlanta, Georgia, at which Dr. Rich received the SAM New Investigator Award for this work. The development and pilot implementation of the VIA methodology was funded in part by the John W. Alden Trust, Arthur Vining Davis Foundations, Deborah Munroe Noonan Memorial Fund, Gerondelis Foundation, Agnes M. Lindsay Trust, and the Mary A. and John M. McCarthy Foundation. The authors thank

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