The effect of goal setting in asthma self-management education: A systematic review

[History of patient education for chronic diseases (with diabetes mellitus as an example): from an idea to the branch of modern medicine]

The article describes the history of the formation of therapeutic education as one of the most essential components of the treatment of chronic diseases, in particular diabetes. The varieties and methods of programs for patients existing in the Russian Federation are considered in detail.

Therapeutic patient education: Impact on lung function in Moroccan adult asthma patients?

BACKGROUND

Despite the availability of effective asthma medications, the condition remains poorly controlled, making it one of the most common emergency room and physician visits each year. Appropriate asthma education programs are needed to maintain or improve optimal lung function in asthmatics. This study aimed to evaluate changes in lung function parameters in adult asthmatics before and after a structured educational intervention.

METHODS AND MATERIALS

We conducted a quasi-experimental study with 157 adult asthma patients in the Pneumology Department of the Hassan II University Hospital in Fez, Morocco. The study was performed in three phases: patient recruitment and baseline data collection (March-May 2022), planning and implementation of educational sessions (June-July 2022), and lung function evaluation 3 months later (September-October 2022) after training. Sociodemographic and clinical data were collected through a questionnaire. Spirometry was also performed before education and 3 months after. All patients received a structured and collective educational intervention. Pre- and post-education results were compared using the Wilcoxon test for qualitative variables and the paired sample t-test for quantitative variables.

RESULTS

There was a statistically significant improvement (P < 0.001) in pulmonary function parameters (as a percentage of the reference value): forced expiratory volume in one second (FEV1), forced vital capacity (FCV), and peak expiratory flow rate (PEFR) sequentially increased from 66.73 ± 20.84 to 70.64 ± 19.06; 74.74 ± 17.29 to 79.67 ± 16.15 and 67.51 ± 23.39 to 71.93 ± 21.57.

CONCLUSIONS

Our results suggest that an educational intervention can be beneficial in reducing alterations in lung function in adult asthmatics.

An umbrella review of the literature on the effectiveness of goal setting interventions in improving health outcomes in chronic conditions

PURPOSE

To identify the contexts in which goal setting has been used in chronic disease management interventions and to estimate the magnitude of its effect on improvement of health outcomes.

METHODS

The strength of evidence and extent of potential bias in the published systematic reviews of goal setting interventions in chronic conditions were summarized using AMSTAR2 quality appraisal tool, number of participants, 95% prediction intervals, and between-study heterogeneity. Components of goal setting interventions were also extracted.

RESULTS

Nine publications and 35 meta-analysis models were identified, investigating 25 health outcomes. Of the 35 meta-analyses, none found strong evidence and three provided some suggestive evidence on symptom reduction and perceived well-being. There was weak evidence for effects on eight health outcomes (HbA1c, self-efficacy, depression, anxiety, distress, medication adherence, health-related quality of life and physical activity), with the rest classified as non-significant. Half of the meta-analyses had high level of heterogeneity.

CONCLUSION

Goal setting by itself affects outcomes of chronic diseases only to a small degree. This is not unexpected finding as changing outcomes in chronic diseases requires a complex and individualized approach. Implementing goal setting in a standardized way in the management of chronic conditions would seem to be a way forward.IMPLICATIONS FOR REHABILITATIONThe link between goal setting and health outcomes seems to be weak.Some levels of positive behavioural change could be of benefits to patients as seen by improved self-efficacy, patients' satisfaction and overall quality of life.Systematic and consistent application of personalized goal-oriented interventions considering patient's readiness to change could better predict improved outcomes.Incorporation of various goal setting components while actively engaging patient and/or their care givers in the process could appraise how goal setting could help with challenges in faced by people living with chronic conditions in different areas.

Life Course of Asthma

Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.