Making childhood asthma management education happen in the community: translating health behavioral research into local programs

Self-Management of Chronic Disease by Older Adults

This article summarizes the literature describing the at-home management of and psychosocial coping with five chronic diseases (heart disease, asthma, chronic obstructive pulmonary disease, arthritis, and diabetes) by the general population of adults. It also reviews the literature describing self-management of these chronic diseases by older adults. Conclusions drawn subsequent to the review are (a) that there are strong commonalities in the essential nature of tasks that exist across disease entities, (b) that the context for self-management of disease by the ill elderly is likely to differ somewhat from the context for other age groups. Questions for future research are posed.

A training program for certified asthma educators: assessing performance

BACKGROUND

Evidence-based asthma guidelines identify asthma education as an essential element of care. In Canada, a process for certifying asthma educators was established to help provide asthma education to patients. A critical component to certifying asthma educators is their training and evaluation. The purpose of the study was to identify an approach to evaluate participants and to determine if specific characteristics influenced participants' success.

METHODS

Participants completed a questionnaire that collected demographic, practice, and learner characteristics. Assessment strategies and criteria used to determine the level of success included 1) a written asthma knowledge score; 2) a written educational theory score, and 3) a practice teaching skill score based on three encounters with standardized patients. Standardized patient encounters were scored by using a standard checklist of essential teaching functions.

RESULTS

Participants (n = 73) represented a broad range of health professions (respiratory therapists, nurses, pharmacists, and physiotherapists). The average score for written asthma knowledge, educational theory, and practice skill assessment was 82.0 +/- 8.0%, 68.6 +/- 16.2%, and 80.3 +/- 9.7%, respectively. Moderate interrelationships were observed between the practice teaching skills score and years of practice in asthma (r = 0.35; p < 0.01) and percentage of workdays dedicated to asthma care (r = 0.30; p < 0.05). Moderately strong relationships were observed among the three standardized patient encounters. However, there were no associations between participant scores on the written asthma or educational theory examination and the practice skill assessment scores.

CONCLUSIONS

Participants of an asthma educator training program represent a wide range of disciplines, practice settings, and experience. It is important that asthma educator training programs assess both written knowledge and practice assessments to evaluate participants.

A randomized field trial of ACINDES: a child-centered training model for children with chronic illnesses (asthma and epilepsy)

A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8-10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls = .69 for epilepsy and .56 for asthma, with sigma2 = .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain = .62 (sigma2 = .0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P = .036 and P = .026). Visits to physicians showed a significant decrease for those with asthma (P = .048), and emergency visits decreased for those with epilepsy (P = .046). An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P < .01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winter P = .006, and spring P = .029; for the group with epilepsy, P = .011).

CONCLUSION

The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.

Self-management of asthma by adult patients

Review of eighteen adult self-management education program evaluations comprising clinical trials showed significant achievement in five categories of outcome: (1) asthma knowledge; (2) patient perceptions and psychological status; (3) behavior related to medicine use, delivery devices and environmental triggers; (4) functioning and control of symptoms; and (5) health care use. Not every program achieved in all of these categories, probably because interventions of adequate power to elicit change in one category of outcome were not powerful enough to realize change in another category. An alternative explanation may be that in some studies assessment measures were inadequate. Asthma management by patients is influenced by their social environment and this aspect of control is least well understood. A small qualitative study suggested themes among adult patients that describe intra- and interpersonal factors enabling or hindering self-management including: the ability to acquire information; self-regulation; relations with family, friends and coworkers; and, relationships with clinicians. Research is needed that provides greater understanding of social environments in asthma management, produces standardized measurement tools, and tests more robust and theory-based interventions.

Patient, professional, and public education on behavioral aspects of asthma: a review of strategies for change and needed research

Combating increases in asthma morbidity and mortality necessitates an understanding of social and behavioral aspects of the disease. Education for patients, professionals, and the public based on the most current scientific information is required. This paper reviews the existing research on patient education and management of asthma. It discusses physician and family interaction related to asthma management; identifies gaps in the current understanding of relevant patient, professional, and public behavior; outlines needed strategies to improve asthma education; and poses recommendations for further research.

Self-management skills for cooperative care in asthma

The increases in morbidity and mortality rates from asthma over the last decade may be attributable in part to delayed and ineffective action on the part of patients and parents. Providing information about this disorder and educating patients, families, and communities in asthma self-management and cooperative-care skills may help reverse these trends. Such programs are designed to complement the traditional health care system and include instruction about the pathophysiology of asthma, ways to recognize and treat symptoms, adverse drug effects, and the need for professional assistance. In this article are outlined seven exemplary asthma self-care programs available to physicians and other health care providers.

Living with asthma: Part II. Beyond CARIH

This article focuses on the evolution and assessment of additional self-management programs and strategies following the original development and evaluation of Living with Asthma. In particular, it describes the basis and philosophy underlying a self-management program for adults with asthma. In doing so, it introduces strategies that can be used by adults to process and evaluate the information they gather, and to make decisions as to what steps to take to predict and prevent asthma attacks. These strategies rely upon techniques ranging from the use of decision-making trees to the calculation of conditional probabilities to enhance the patients' knowledge that an attack is apt to occur within a prescribed period. It is hoped that further refinement of these procedures will not only provide greater control over asthma, but may help reverse the recent trend of increased mortality due to the disorder.