Asthma Self-management Skills Research Articles

Coping with asthma in immigrant Hispanic families: a focus group study

Little is known about how childhood asthma affects immigrant Hispanic families in the United States. Qualitative research is effective for understanding the social, cultural, functional, and structural aspects of asthma in the family context. Furthermore, such knowledge is necessary to develop culturally appropriate interventions for these families. To describe participants' perceptions of their roles in caring for an asthmatic child, to compare family patterns of caring for an asthmatic child by parents' country of origin, to identify barriers to caring for an asthmatic child, and to evaluate specific coping needs of low-income immigrant Hispanic families caring for an asthmatic child. Five focus groups were conducted with low-income, immigrant, Spanish-speaking Hispanic adults caring for an asthmatic child, including community health workers, mothers, fathers, and grandparents, along with women with asthma. Audiotaped focus groups were transcribed verbatim in Spanish, forward translated into English, and back translated into Spanish. Data analysis was performed using qualitative analytic methods. Forty-one participants represented a range of countries of origin. Different themes emerged for community health workers vs parents and grandparents and for women vs men caring for a child with asthma. All the participants reported strong beliefs in using folk medicines. Barriers identified included language, culture, poverty, lack of health insurance, and poor living conditions. Results highlight the lack of asthma self-management skills, diagnostic uncertainty, and the use of folk medicine as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in this vulnerable population.

A Randomized, Controlled Trial of an Interactive Educational Computer Package for Children With Asthma

The purpose of this study was to evaluate the impact and acceptability of an educational multimedia program designed to promote self-management skills in children with asthma. We conducted a randomized, controlled trial with measures at baseline and 1- and 6-month follow-up. The trial was conducted in pediatric outpatient respiratory clinics in 3 United Kingdom hospitals. Participants included 101 children aged 7 to 14 years under the care of hospital-based asthma services. The children were randomly assigned to receive an asthma information booklet alone or the booklet plus The Asthma Files, an interactive CD-ROM for children with asthma. Asthma knowledge was the primary outcome measure. Other measures included asthma locus of control, lung function, use of oral steroids, and school absence. At the 1-month follow-up (n = 99), children in the computer group had improved knowledge compared with the control group and a more internal locus of control. There were no differences in objective lung-function measures, hospitalizations, or oral steroid use. The study participants were positive in their evaluation of the intervention. At the 6-month follow-up (n = 90), significantly fewer children in the intervention group had required oral steroids and had had time off school for asthma in the previous 6 months. The difference did not reach statistical significance in the intention-to-treat analysis for both steroid use and school absence. The Asthma Files was found to be an effective and popular health education tool for promoting asthma self-management skills within pediatric care.

Coping with Asthma in Immigrant Hispanic Families: A Focus Group Study

RATIONALE: Little is known about how childhood asthma impacts low income immigrant (LII) Hispanic families within the United States. Qualitative research is effective for understanding the social, cultural, functional, and structural aspects of asthma within the family context. We aimed to describe participants' perceptions of their role in caring for an asthmatic child; to compare the patterns of family caring for an asthmatic child by parents' country of origin; to identify barriers to caring for an asthmatic child; and to assess specific coping needs of LII Hispanic families caring for an asthmatic child. METHODS: Five focus groups were conducted with LII Spanish-speaking Hispanic adults caring for an asthmatic child, including community health workers (CHWs), mothers, fathers, and grandparents. Audiotaped focus groups were transcribed verbatim in Spanish, forward translated into English, and back translated into Spanish. Data analysis was performed using qualitative analytic methodology. RESULTS: Forty-one participants represented diverse countries of origin. Different themes emerged for CHWs versus parents and grandparents. Similarly, women and men had slightly different perspectives on their roles in caring for the child. All participants reported strong beliefs in using folk medicines to treat asthma. Immigrant mothers described a lack of adequate social support for having a child with asthma. Barriers identified included fear, language, culture, poverty, lack of health insurance, and poor living conditions. CONCLUSIONS: Results highlight the lack of asthma self-management skills, diagnostic uncertainty, and use of folk medicines as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in this vulnerable population.

Asthma self-management skills and the use of asthma education during pregnancy

During pregnancy, patients with asthma are at risk of poor outcomes, particularly when asthma is poorly controlled. The aim of this study was to determine the level of asthma self-management skills and knowledge among pregnant subjects and describe the implementation of an asthma education programme delivered in an antenatal clinic setting. Pregnant subjects with asthma were assessed by an asthma educator at 20 (n = 211) and 33 weeks gestation (n = 149). Lung function, symptoms, medication use, adherence, knowledge and inhaler technique were assessed. They were asked whether they had a written asthma action plan, or performed peak flow monitoring. Asthma was classified as mild, moderate or severe. At the first visit with the asthma educator, 40% of females reported nonadherence to inhaled corticosteroids, inhaler technique was assessed as inadequate in 16% and 42% had inadequate medication knowledge. Peak flow monitoring was performed by 3% and 15% had a written action plan. There were significant improvements in all aspects of asthma self-management following education. In females with severe asthma, night symptoms and reliever medication use significantly decreased after education. In conclusion, during pregnancy, patients with asthma have poor asthma knowledge and skills, and may benefit from self-management education as part of their obstetric care.

Tailored Education May Reduce Health Literacy Disparities in Asthma Self-Management

Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown. In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique. At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique. Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators. These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.

Tackling paediatric asthma – The time has come

Tackling paediatric asthma – The time has come

Asthma education: the adolescent experience

Recent studies show that prevalence of asthma is higher among adolescents than children. Adolescents have poor asthma self-management skills resulting in a significant increase in the severity of asthma exacerbations and a reduction in their quality of life. Despite this, few self-management programs have been developed for adolescents. Adolescents experience developmental transitions that both hinder and facilitate asthma self-management. In this paper we discuss developmental transitions in cognition, knowledge, autonomy, identity development, and peer relations in terms of their influence on adolescents’ management of asthma. Next, we describe the Asthma Self-Management for Adolescents (ASMA) program that incorporates developmental characteristics into an age-appropriate school-based asthma education program. Preliminary data is presented indicating that the program is successful in enrolling and engaging the interest of adolescents with persistent asthma.

Relations among asthma knowledge, treatment adherence, and outcome

Background: Asthma knowledge is frequently assumed to be a prerequisite for optimal asthma treatment. However, the validity of existing asthma knowledge questionnaires has not been rigorously examined, and no contemporary measure of asthma knowledge has received widespread acceptance. Objective: To construct and examine the psychometric properties of an asthma knowledge instrument, and its association with demographic and psychosocial variables, asthma medication adherence, and treatment outcome. Methods: A 25-item Asthma Knowledge Questionnaire was developed with input from national pediatric asthma experts. Parents of 155 children with asthma completed the Asthma Knowledge Questionnaire as well as demographic, family functioning, and home environment measures. Asthma outcomes and adherence with inhaled medication was measured across 12 months. Results: Despite the many steps taken to develop a strong measure of asthma knowledge, reliability was relatively poor. There was also no association between asthma knowledge and treatment adherence or outcomes. Furthermore, asthma knowledge was not a unidimensional construct and was not a simple function of education. Conclusions: Findings from this study, in combination with previous studies of asthma knowledge questionnaires, suggest that the construction of a simple self-report asthma knowledge instrument for use as a primary outcome measure demonstrating mastery of asthma self-management skills may not be achievable. (J Allergy Clin Immunol 2003;111:498-502.)

Risk factors for lack of asthma self-management knowledge among ED patients not on inhaled steroids

The study objective was to estimate the level of asthma knowledge and self-management skills among asthmatic patients who are not on inhaled corticosteroids and who present with acute asthma to the emergency department (ED). The design was to interview of patients by telephone at 90 to 100 days after enrollment in the Fourth Multicenter Airways Research Collaboration (MARC-4), a randomized trial comparing inhaled fluticasone versus placebo in addition to standard post-ED therapy. The setting was a multicenter trial involving 41 US urban EDs. Persons aged 12 to 54, not on inhaled steroids, who presented to the ED with acute asthma were studied. Of the 617 patients enrolled on MARC-4 405 (66%) were contacted. Mean (+/-SD) age was 30 (+/-11); 54% were women; acute asthma severity was 44% moderate and 56% severe; and 9% had prior intubation. Twenty percent (95% CI 16%-24%) responded that asthma could not be monitored and 40% (95% CI 35%-44%) scored low on a hypothetical acute asthma attack scenario. Predictors for lack of asthma knowledge and self-management skills were: less than a high school education; current smoking; lower median household income; and no history of steroid use. These data suggest that many ED patients with asthma have poor knowledge of asthma monitoring and poor self-management skills and that a "high risk" group is also identifiable. Efforts to design and implement an ED-based educational program should be tailored to better meet the needs of this high risk group.

An Evaluation of Open Airways for Schools: Using College Students as Instructors

Fifteen years ago, Open Airways for Schools (OAS) was found to be an effective asthma education program for elementary school children when taught by professionals. To determine whether OAS is effective when taught by college students and whether it could withstand potential cohort effects, 54 inner-city fourth and fifth graders were taught OAS. Paired t-tests revealed that OAS improved asthma knowledge, self-efficacy, self-management skills, social support, and perception of well-being (p < 0.05). Fifteen years later, OAS continues to improve children's self-management skills. Facilitators with little prior experience who received brief training in asthma knowledge and group leadership skills can effectively teach OAS.

A Self-Management Program for Adult Asthma. III. Maintenance and Relapse of Skills

Patient self-management programs have become an integral part of asthma treatment. The goal of such programs is to strengthen the partnership between patients and health care providers in controlling the condition. The present study analyzed how well patients maintained or relapsed in performing asthma self-management skills over time and across settings. It was conducted by contacting patients who had been involved in a successful self-management program an average of 6 years after their participation or an average of 7 years after they completed training. Seventy percent of the patients agreed to participate and complete, either by themselves or over the telephone, a structured interview regarding their experiences in performing asthma self-management.On the basis of their responses, 53 participants were categorized into two groups: continuers or relapsers, according to previously developed and published criteria for relapse. Characteristics that distinguished the two groups were described. As anticipated, those classified as continuers reportedly exhibited broader repertoires of self-management skills across an array of settings. They credited their performance with maintaining control over their asthma. However, two unexpected findings emerged in the study: First, all patients continued to use self-management skills to one degree or another 7 years after they had acquired these skills. Even patients who were categorized as relapsers regularly performed some self-management skills, often involving self-monitoring of their breathing. Second, half of the patients in the relapse group reported that their asthma was in remission and that they were asymptomatic. The self-management skills they reportedly used were performed to monitor and prevent a return of asthma.

Enhancing care for people with asthma: the role of communication, education, training and self-management

Reduction in the morbidity associated with asthma requires attention to several aspects of the behaviour of health professionals and patients, and to the interactions between these two groups. In this review, what has been learnt about health professional/patient communication and patient education (skills, settings and materials), lay and health professional liaison (including telephone helplines), patient education in low-income countries, the integration of patient education into clinical practice, health professional training and the implementation of guidelines, and the role of national asthma campaigns is drawn together. What changes in public policy would enhance asthma care, and whether the promotion of asthma self-management skills is cost effective are also considered. It is concluded that, although further research is necessary in many areas, well-educated health professionals who recognize the person with asthma as an individual, and who give advice about self-management, can significantly reduce the suffering and costs associated with asthma.

Enhancing care for people with asthma: the role of communication, education, training and self-management. 1998 World Asthma Meeting Education and Delivery of Care Working Group.

Reduction in the morbidity associated with asthma requires attention to several aspects of the behaviour of health professionals and patients, and to the interactions between these two groups. In this review, what has been learnt about health professional/patient communication and patient education (skills, settings and materials), lay and health professional liaison (including telephone helplines), patient education in low-income countries, the integration of patient education into clinical practice, health professional training and the implementation of guidelines, and the role of national asthma campaigns is drawn together. What changes in public policy would enhance asthma care, and whether the promotion of asthma self-management skills is cost effective are also considered. It is concluded that, although further research is necessary in many areas, well-educated health professionals who recognize the person with asthma as an individual, and who give advice about self-management, can significantly reduce the suffering and costs associated with asthma.

Lessons from an evaluation of the effectiveness of an asthma day camp.

To evaluate the effectiveness of applied teaching methodologies in a camp setting on asthma self-management skills in school-age children. This was a descriptive pilot study using a one-group pretest-posttest design. Thirty-four subjects, ages 6 to 12 years, representing a typical clinical population of children with asthma. Children's asthma knowledge, symptoms, behavior, and mastery, as well as peak-flow technique, were measured 2 to 3 weeks before camp and then again on the last day of camp. Baseline measures of parents' asthma knowledge and family stress related to asthma were obtained. Outcomes specific to asthma management, such as missed school days, emergency room visits, and hospitalizations, were evaluated by parent report the year before and after the intervention. Significant improvement in peak-flow technique and a reported reduction in emergency room visits and missed school days after camp were found. In this pilot study, the use of an applied teaching format for school-age children in an asthma day camp resulted in some learning. More rigorous design and instrumentation are important for better evaluation of programs such as this. Nurses working with these populations should plan structured evaluations of the programs so they can best meet the children's needs.

Parental self-efficacy and asthma self-management skills.

To determine whether a formal asthma self-management program and social support using lay health advisors increases parent self-efficacy in the management of their child's asthma, and whether parent self-efficacy predicts asthma self-management skills. Quasi-experimental with four time points measured over 2 years. Low-income, primarily Hispanic parents (N = 303) of children with moderately severe to severe asthma. A Southwestern university medical setting in a rural state. Parent self-efficacy and parent asthma self-management skill score scales. Parent self-efficacy increased significantly from baseline, but there were no significant differences between the control and treatment groups. The increase in self-efficacy was apparent at 6 months, then leveled off. Parent self-efficacy at either baseline or 12 months did not predict parents' asthma self-management skill score. Individual education was just as effective as group education in increasing parental self-efficacy. Parents felt more comfortable treating asthma episodes than preventing them, thus clinicians need to spend time teaching preventive strategies.

Asthma education programme in Russia: educating patients

To address the recent rise in asthma morbidity and mortality in Russia, an intervention study was conducted to improve asthma diagnosis, treatment and prevention. US recommendations for asthma management were adapted for use in educating Moscow families with children with asthma. Two hundred and fifty-two children with asthma aged 4–14 years receiving health care in eight Moscow public health clinics together with their parents were enrolled in the study to see whether US teaching manuals for asthma management would be acceptable and effective in Russia. Children at four of the clinics with recent asthma attacks were randomly assigned to either the education or control group to test if patient education and guided asthma care would improve outcomes for patients. Modern medications were made available to both groups to see if training in the US guidelines was necessary to get physicians to use the medications. Children with recent asthma attacks at the other four clinics were defined as comparison group 1 to control for the possible effect of medication availability. All children at the eight clinics who had no asthma attacks composed comparison group 2 to see if the outcomes for these children would change over time. One-year follow-up results showed significant improvement in asthma self-management skills of children and parents, in terms of asthma treatment, only among those in the education group. Significant increases were observed in the subgroup of children in the education group using anti-inflammatory drugs for asthma control. Children in the education group had markedly increased peak flow rates and reduced daily peak flow variability as compared to control and comparison groups. There was a significantly greater reduction in doctor visits by the education group of children compared to control. Presumably, changes in parents' and children's behaviour in terms of asthma treatment and prevention skills, proper treatment of the disease and access to medications could be responsible for reducing asthma morbidity in children.

Factors Associated With Emergency Department Dependence of Patients With Asthma

Dependence on crisis-oriented care rather than continuous ambulatory care for asthma is thought to contribute to asthma morbidity and mortality. We contrasted the characteristics of patients who depend on emergency department (ED) care for the management of their asthma exacerbations to the characteristics of patients employing self-management plans in an ambulatory setting. In prospective fashion, we used a structured interview and charted information to survey two cohorts of patients suffering from an acute exacerbation of asthma; those seen in a hospital ED (n = 80) and those seen in an ambulatory asthma care facility (Asthma Center [AC]) (n = 40) at the same hospital. We looked for differences in socioeconomic characteristics, asthma severity, asthma knowledge, and asthma self-management skills between groups. There were no significant differences in mean age (SD) (ED vs AC: 36.65 [13.8] vs 40 [13.8] years) or female to male ratio (ED vs AC: 2/1 vs 2.5/1) between the two groups. There were no major differences in ethnic origin, educational status, marital status, smoking history, employment status, number of children in the household, possession of an extended health insurance plan, sick leave benefits, and child care availability between the two groups. Patients seeking ED care were more likely to have resided in the city for < 5 years (34% vs 8%; p < 0.05), and more likely to be living alone (35% vs 15%; p < 0.05). Significantly more patients from the ED group had a below average gross annual income (55% vs 3%; p < 0.05). There were several significant differences between groups in their knowledge of asthma and its therapy. Most striking, 79% of AC patients reported having a predetermined crisis plan vs just 23% of ED patients (p < 0.001). Although measurements of airflow (percent predicted FEV1) were significantly lower in the ED group than the AC group (mean, 50% vs 78.4%; p < 0.001), other indexes reflecting the degree of asthma severity over the long term such as past use of oral steroids, history of hospitalization, or ICU admission for asthma and the mean total days of disability within the preceding year were not significantly different between the two groups. Most of the ED patients had more than one previous visit to the ED for asthma exacerbation within the preceding year while most exacerbations of AC patients had been treated in the ambulatory care setting. Only 17% of ED patients initiated or increased inhaled or oral steroids before seeking medical care vs 89% of AC patients (p < 0.001). We conclude that a subgroup of asthmatics depends primarily on crisis-oriented care for the management of asthma. These patients are more likely to have lower income, to live alone, and to have resided at their current address for less time than patients seeking less urgent ambulatory care. Moreover, such patients are less knowledgeable about asthma and its management and are less likely to have a predetermined crisis plan.

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.

Genitourinary Tuberculosis

BACKGROUND--Previous work has indicated a high rate of non-attendance at hospital based clinics among young, multiracial asthmatic patients of lower socioeconomic class. The efficacy of delivering asthma education from a community health centre established in a multiracial working class neighbourhood was evaluated. METHODS--A prospective controlled study was performed in which asthmatic subjects aged between two and 55 years attending a hospital emergency room with acute asthma and living within a defined geographical area of high emergency room users were randomised to the usual follow up or the education centre plus usual follow up. Measurements were taken at entry into the study and again nine months later. RESULTS--At nine months patients randomised to the education centre had more preventive medications, more peak expiratory flow meters and better flow meter technique, more self-management plans, better knowledge of appropriate action to take when confronted with worsening asthma, less nocturnal awakening, and better self-reported asthma control than the control group. There was no difference between the study groups in measurements of compliance, hospital admission, days lost from school or work, or emergency room use. CONCLUSIONS--The main effects of education were on asthma knowledge and self-management skills, whilst improvements in asthma morbidity were small. Potential reasons for this include heterogeneous study population (in terms of baseline self-management skills, asthma severity, ethnicity and age), pragmatic study design, insensitivity of many of the measurements of morbidity, the modest effectiveness of a single time limited education programme, and inability to limit the effects of such a large community based study to the intervention group (there was a 67% reduction in asthma admissions during the study period from the geographical area targeted compared with a 22% reduction for the rest of Auckland).