Home-based Education Research Articles

Effectiveness of Nebulizer Use–Targeted Asthma Education on Underserved Children With Asthma

To determine the effectiveness of a home-based asthma education intervention in increasing appropriate nebulizer use and reducing symptom frequency, emergency department (ED) visits, and hospitalizations over 12 months. A randomized clinical trial. Settings Pediatric primary care, pulmonary/allergy, and ED practices associated with the University of Maryland Medical System and The Johns Hopkins Hospital, Baltimore. Children with persistent asthma, aged 2 to 9 years, with regular nebulizer use and an ED visit or hospitalization within the past 12 months. Children were randomized into the intervention (n = 110) or control (n = 111) group. Follow-up data were available for 95 intervention and 86 control children. Home-based asthma education, including symptom recognition, home treatment of acute symptoms, appropriate asthma medication, and nebulizer practice. Estimates of mean differences in asthma symptom frequency, number of ED visits and hospitalizations and appropriate quick relief, controller medication, and nebulizer practice over 12 months. Of the 221 children, 181 (81.9%) completed the study. There were no significant differences in home nebulizer practice, asthma morbidity, ED visits, or hospitalizations between groups (P range, .11-.79). Although most children received appropriate nonurgent asthma care (mean, 2 visits per 6 months), more than one third of all children received at least 6 quick-relief medication prescriptions during 12 months, with no difference by group. A nebulizer education intervention had no effect on asthma severity or health care use. Of concern is the high quick-relief and low controller medication use in young children with asthma seen nearly every 3 months for nonurgent care.

Evaluation of a Community‐Based Outreach Worker Program for Children With Asthma

An asthma outreach worker (AOW) can provide home-based education about asthma management and methods to minimize home environmental asthma triggers. A theory-based AOW program was implemented by a community partnership and its effectiveness was evaluated. Baseline and follow-up surveys were used to evaluate the effectiveness of the AOW. The convenience sample consisted of 60 caregivers whose children received AOW services. Quality of life, use of asthma management plans, medication use, health care utilization, home environmental behavior changes to reduce triggers, and satisfaction with AOW services were self-reported by caregivers. Caregivers reported significantly higher quality of life at follow-up than at baseline. At follow-up, 93% of the children had asthma management plans as compared with 31% at baseline. Self-reported hospitalizations were significantly reduced. All of the families made changes to minimize household asthma triggers. Caregivers reported high satisfaction with the AOW and 90% of them felt that the home environmental assessment conducted by the AOW helped improve their child's asthma. Short-term community-based AOW services for children can be effective in enhancing self-management capabilities, improving the quality of life, increasing the use of asthma management plans, and helping families reduce asthma triggers in the home environment.

Home environmental intervention in inner-city asthma: a randomized controlled clinical trial

Airborne pollutants and indoor allergens increase asthma morbidity in inner-city children; therefore, reducing exposure, if feasible, should improve asthma morbidity. To conduct a randomized controlled trial of methods to reduce environmental pollutant and allergen exposure in the homes of asthmatic children living in the inner city. After the completion of questionnaires, spirometry and allergen skin tests, home inspection, and measurement of home air pollutant and allergen levels, 100 asthmatic children aged 6 to 12 years were randomized to the treatment group (home-based education, cockroach and rodent extermination, mattress and pillow encasings, and high-efficiency particulate air cleaner) or to the control group (treated at the end of the 1-year trial). Outcomes were evaluated by home evaluations at 6 and 12 months, clinic evaluation at 12 months, and multiple telephone interviews. In the treatment group, 84% received cockroach extermination and 75% used the air cleaner. Levels of particulate matter 10 microm or smaller declined by up to 39% in the treatment group but increased in the control group (P < .001). Cockroach allergen levels decreased by 51% in the treatment group. Daytime symptoms increased in the control group and decreased in the treatment group (P = .04). Other measures of morbidity, such as spirometry findings, nighttime symptoms, and emergency department use, were not significantly changed. A tailored, multifaceted environmental treatment reduced airborne particulate matter and indoor allergen levels in inner-city homes, which, in turn, had a modest effect on morbidity.

Outcomes of a Community– and Home-Based Intervention for Safe Motherhood and Newborn Care

Mothers and their home birth attendants residing in rural Uttar Pradesh (UP), India, were taught to recognize and take action to resolve selected maternal and neonatal life-threatening problems. Community mobilization efforts were designed to reduce delays in transport to emergency obstetric care (EOC) referral units and to increase use of family planning. Retention of knowledge and skills for recognition and intervention for maternal bleeding and newborn sepsis was enhanced when pictorial depictions of the problem or take action message or both were used as memory aids. Advocacy efforts for use of EOC facilities were less successful. The community health promotion and home-based life-saving skills education efforts tested are recommended for replication.

Rct Of A Physical Activity Intervention For Obesity Prevention In Pre-school Children

Prevalence of obesity is extremely high and increasing in pre-school children in the UK, but recent systematic reviews have concluded that there are no simple, generalisable, and successful obesity prevention strategies available. PURPOSE To test whether a simple combined nursery and home-based intervention reduced BMI Z-score (primary outcome) over 6 and 12 months. Secondary outcomes were changes in motor skills, physical activity and sedentary behavior (measured by accelerometry), waist circumference, and blood pressure. We also carried out a process evaluation. METHODS Pragmatic blinded cluster randomized controlled trial in thirty-six nurseries (n 545 children, mean age 4.1 years at baseline) in Glasgow, Scotland. Intervention consisted of a 6 month enhanced physical activity programme in nursery (90 minutes/week) plus homebased health education aimed at increasing physical activity and reducing sedentary behavior. Control nurseries received standard curriculum during the same period and no home-based intervention. RESULTS Children in the intervention nurseries showed a significantly greater improvement in motor skills than the control children, but the two groups did not differ significantly for any other outcome measure at 6 and 12 months. The intervention was implemented successfully, with 70% of nursery activity sessions delivered as prescribed. CONCLUSIONS The intervention successfully improved motor skills but did not have the desired effects on other outcome measures in this study despite a successful pilot study and fairly good implementation.

Home‐Based Asthma Self‐Management Education for Inner City Children

Optimal home self-management in young children with asthma includes accurate symptom identification followed by timely and appropriate treatment. The objective of this study was to evaluate a home-based asthma educational intervention targeting symptom identification for parents of children with asthma. Two hundred twenty-one children with asthma were enrolled into an ongoing home-based clinical trial and randomized into either a standard asthma education (SAE) or a symptom/nebulizer education intervention (SNEI). Data included home visit records and parent's self-report on questionnaires. Symptom identification and self-management skills significantly improved from preintervention to postintervention for parents in both groups with the exception of checking medications for expiration dates and the frequency of cleaning nebulizer device and equipment. However, significantly more parents of children in the SNEI group reported treating cough symptoms as compared with the SAE group (p = 0.05). Of concern is that only 38% of all parents reported having an asthma action plan in the home. A targeted home-based asthma education intervention can be effective for improving symptom identification and appropriate use of medications in children with asthma. Home asthma educational programs should address accurate symptom identification and a demonstration of asthma medication delivery devices.

Reduced Incidence of Neonatal Morbidities: Effect of Home-Based Neonatal Care in Rural Gadchiroli, India

We found a high burden of morbidities in a cohort of neonates observed in rural Gadchiroli, India. We hypothesised that interventions would reduce the incidence of neonatal morbidities, including the seasonal increase observed in many of them. This article reports the effect of home-based neonatal care on neonatal morbidities in the intervention arm of the field trial by comparing the early vs late periods, and the possible explanation for this effect. During 3 years (1995 to 1998), trained village-health-workers (VHWs) in 39 villages prospectively collected data by making home visits during pregnancy, home-delivery and during neonatal period. We estimated the incidence and burden of neonatal morbidities over the 3 years from these data. In the first year, the VHWs made home visits only to observe. From the second year, they assisted mothers in neonatal care and managed the sick neonates at home. Health education of mothers and family members, individually and in group, was added in the third year. We measured the coverage of interventions over the 3 years and evaluated maternal knowledge and practices on 21 indicators in the third year. The effect on 17 morbidities was estimated by comparing the incidence in the first year with the third year. The VHWs observed 763 neonates in the first year, 685 in the second and 913 in the third year. The change in the percent incidence of morbidities was (i) infections, from 61.6 to 27.5 (-55%; p<0.001), (ii) care-related morbidities (asphyxia, hypothermia, feeding problems) from 48.2 to 26.3 (-45%; p<0.001); (iii) low birth weight from 41.9 to 35.2 (-16%; p<0.05); (iv) preterm birth and congenital anomalies remained unchanged. The mean number of morbidities/100 neonates in the 3 years was 228, 170 and 115 (a reduction of 49.6%; p<0.001). These reductions accompanied an increasing percent score of interventions during 3 years: 37.9, 58.4 and 81.3, thus showing a dose-response relationship. In the third year, the proportion of correct maternal knowledge was 78.7% and behaviours was 69.7%. The significant seasonal increase earlier observed in the incidence of five morbidities reduced in the third year. The home-based care and health education reduced the incidence and burden of neonatal morbidities by nearly half. The effect was broad, but was especially pronounced on infections, care-related morbidities and on the seasonal increase in morbidities.

A Home Visiting Asthma Education Program: Challenges to Program Implementation

This study describes the implementation of a nurse home visiting asthma education program for low-income African American families of young children with asthma. Of 55 families, 71% completed the program consisting of eight lessons. The achievement of learning objectives was predicted by caregiver factors, such as education, presence of father or surrogate father in the household, and safety of the neighborhood, but not by child factors, such as age or severity of asthma as implied by the prescribed asthma medication regimen. Incompatibility between the scheduling needs of the families and the nurse home visitors was a major obstacle in delivering the program on time, despite the flexibility of the nurse home visitors. The authors suggest that future home-based asthma education programs contain a more limited number of home visits but add telephone follow-ups and address the broader needs of low-income families that most likely function as barriers to program success.

Spectrum of Early Intervention Services for Children With Intrauterine Drug Exposure

Intrauterine illicit drug exposure may lead to a variety of adverse neurobehavioral and neurodevelopmental outcomes. Providing early intervention to reduce the impact of maternal substance abuse on the developing fetus may have significant benefits for the child and family. In this article we report on 3 promising intervention programs designed to improve the well-being of parents with drug dependence and their children. The initiation of these programs spans from pregnancy through early childhood. All 3 programs are community-based using comprehensive culturally relevant developmental models. The first program was developed to provide comprehensive care for pregnant women with drug dependence and their newborns. Project STRIVE (Support Trust Rehabilitation Initiative Values and Education) provided substance abuse treatment intensive center- and home-based social work and parent education onsite at a high-risk obstetric and pediatric clinic. The second program the Early Infant Transition Center enrolled newborns with a history of neonatal abstinence syndrome and their mothers. Based in a renovated rowhouse in East Baltimore one block away from a major urban hospital the Early Infant Transition Center provided 24-hour nursing care oncall physicians and nurse practitioners social workers parent education and onsite sleeping accommodation for parents during their infant’s recovery. The third programs Home-U-Go Safely used community-based nurses to give home-based health monitoring education and support to new mothers with a history of cocaine and/or opiate dependence. (authors)

Analyses of Parents and Teachers' Perceptions on Private Itinerary Home-Based Education for Children with Disabilities

현재 우리나라에서 시행되는 특수교육 서비스는 크게 특수학교ㆍ특수학급ㆍ통합학급ㆍ순회교육의 네 가지로 분류된다. 순회교육의 대다수를 차지하는 재택ㆍ순회교육의 경우 학령기의 특수학교 중심의 재택ㆍ순회교육에 관한 연구만 주로 이루어지고 있는 상황이다. 본 연구에서는 취학 전을 포함하는 다양한 연령 대와 일반학급에 통합되어 있는 특수교육 재택ㆍ순회교육에서도 소외된 장애아동에게 서비스를 제공하고 있는 사설 재택ㆍ순회교육에 대한 기초 자료 제공에 그 목적을 두고, 현재 사설 재택ㆍ순회교육을 받고 있는 부모 22명과 시행하고 있는 교사 20명의 욕구와 만족도를 조사하여 분석하였다. 연구의 결과, 두 집단은 거의 대부분의 항목에서 통일치를 보였으나, 부모와 담당교사의 욕구에서 교육 시간대ㆍ주당 교육 횟수ㆍ효율적 운영을 위한 필요 사항 등에서 통계적으로는 유의하지 않지만 차이점을 보였다. 만족도에서는 교육비에 대한 부모의 의견이 비싸다고 나타난 것을 제외하고는 두 집단간의 비교에서 유의한 차이점이 없었다. 개방형 질문인 장애아동 사설 재택ㆍ순회교육의 개선 방향에 있어 부모는 국가의 교육비 지원과 교사인건비 지원, 교육기관의 확대 등을 제시한 반면에, 담당교사는 평가도구 및 교재교구의 지원, 보수교육을 통한 전문성 확립 등을 더 강조하였다. 이상의 결과들을 바탕으로 논의들이 제시되었다.

EJIAS and the Bristol‐Myers Squibb Foundation's Secure the Future Program

Secure the Future, Bristol-Myers Squibb's landmark $115 million program to offer care and support for the women and children affected and infected by HIV/AIDS in 9 countries in Southern and Western Africa, recently marked its 5-year anniversary. During that time it has supported nearly 200 programs in these countries to offer new approaches to medical research and care and community outreach and education, especially in resource-limited settings. These projects have included new studies focusing on mother-to-child transmission of HIV after birth, the development of CD4 tests that have reduced costs by up to 80%, the first HIV reference laboratory for HIV diagnosis and testing in Botswana, the first pediatric HIV/AIDS treatment and research center in Africa, and a groundbreaking healthcare training curriculum in HIV/AIDS, along with scores of projects supporting home-based care, counseling, prevention, destigmatization and education, income generation, nutritional support, and much more. In each project, the aim has been to find ways to create sustainable solutions that are appropriate for each setting and to do so in ways that build capacity for the future in each of these areas. Secure the Future recently opened a series of comprehensive community-based treatment and support centers to serve as model programs through which newly available antiretroviral treatments can be delivered, while at the same time offering the kind of community-based support and resources, from counseling to home-based care, that will be required if these treatments are to truly succeed. (Published: 8 July 2004) doi:10.1186/1758-2652-6-3-57 Full text: BioMed Central: http://www.biomedcentral.com/1758-2652/content/6/3/57 PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738663/

Effect of Education on School‐Age Children's and Parents' Asthma Management

Asthma affects 7.4% of school-age children, with poor children or members of ethnic minorities disproportionately affected. A quasiexperimental, year-long pilot study tested the effectiveness of an intervention that included school-based small-group education for children with home-based education for parents. Pretest and two posttest measures were collected. Forty-four families completed the study (41% African American, 36% European American, 23% Mexican American), with 46% coming from poor or working-class families. Asthma management in the treatment group was lower than the comparison group at baseline, but improved significantly at 6 months and stabilized at 12 months, a trend that was most pronounced among the poorer children. Improvements in asthma management point to the need for ongoing asthma education to address learning needs of the children and families.

Home-based asthma education of young low-income children and their families.

GRUS, CATHERINE L. Ph.D.Editor(s): TEPLIN, STUART W. M.D., Editor; GRUS, CATHERINE L. Ph.D.; SANDLER, ADRIAN D. M.D.; REIFF, MICHAEL I. M.D. Author Information

Specialist Nurse-Led Intervention in Outpatients with Congestive Heart Failure

Congestive heart failure (CHF) encompasses a spectrum of clinical syndromes and presentations. It affects 1–2% of the population in the UK and is associated with significant mortality which is comparable to most cancers. It accounts for more than 5% of adult medical admissions in the UK, with significant annual re-admission rates. Improved understanding of the pathophysiology of CHF has resulted in significant advancements in CHF management. Current pharmacologic agents, such as ACE inhibitors, β-adrenoceptor antagonists and spironolactone, influence symptoms and improve mortality. Despite this, many patients still require hospitalization. Multiple, potentially reversible factors are involved which, if addressed effectively, may result in significant reductions in re-admission rates. Patients with CHF often have other conditions, such as respiratory disease, resulting in prolonged lengths of stay. Suboptimal care and failure to adhere to management guidelines is also a preventable cause for re-admission. There has been an increasing need to develop adjunctive, non-pharmacologic strategies for managing CHF, which are designed to improve the patient’s functional status and quality of life. Key elements include systematic follow-up care and patient education. The concept of intensive outpatient or home-based CHF intervention has been developed and extensively evaluated in several randomized controlled trials. Early studies were inconclusive but provided an indication that discharge planning and home-based education are valuable strategies. Recently, an increasing number of studies utilizing the CHF nurse practitioner have provided positive results for non-pharmacologic intervention and demonstrate the potential of these interventions to reduce admissions to hospital by up to 50%. These studies had specific inclusion criteria and could not be generalized to the CHF population as a whole. The Study to Evaluate the effectiveness of Nurse-led Intervention in the management of outpatients with heart Failure (SENIF) explored whether a similar approach to CHF management was beneficial in a typical outpatient population of patients with CHF. Over 12 months, fewer intervention group patients required admission, resulting in 69% fewer hospital days. Cost effectiveness of nurse-led intervention has been suggested in several studies including SENIF, resulting from reduced hospitalizations and re-admissions, which vastly outweighed the modest increase in expenditure required to run the programs. Hospitalizations because of CHF impact greatly on limited healthcare resources. Specialist nurse-led intervention in CHF is a cost-effective, non-pharmacological strategy to help optimize CHF management.

Education for Self-Determination

Control over education is seen as an element of Aboriginal self-government. In the Report of the Aboriginal Justice Inquiry of Manitoba, it states, Aboriginal people seek the right to self-government, they mean the right to determine how matters such as health care, education, and child welfare are provided to their people, in their own communities (Manitoba Public Inquiry 1991, 258). However, if Aboriginal people, in gaining control over education, replicate the schooling system, they will be perpetuating a system that robs people of self-determination. That is, whether it is band-controlled or state controlled, no school system can meet the goals of self-determination in education for Aboriginal people. As a system specifically designed by the dominant society to inhibit such self-determination, it should be scrapped and replaced with a model favoring a home-based education approach. When Egerton Ryerson set up a school system in Ontario in the mid-nineteenth century he began to change the focus of schooling. Under Ryerson, went from focusing on the teaching of basic literacy skills to molding social identities. Ryerson established what is now known as the curriculum--a system that, through the structure and pedagogy of school, tries to shape the behaviour of students. aim was to develop people who willingly accepted the status quo, and this was to be done by establishing school rituals that implicitly taught passivity and submission (Contenta 1993, 11). This school system, geared to teach passivity and submission, was aimed not at Aboriginal people, but at the general public. Aboriginal control of education, if it continues to be delivered in a schooled environment, will not eliminate the lessons of this hidden curriculum. We fail to question school as the only means of delivering education because it is all we have ever known. most of us who experienced state schooling, the contours of the educational map were drawn when we arrived. School practices preceded us and neither we, nor those we knew, had experienced an alternative reality (Curtis 1988, 16). Schooling and education are not synonymous. The construction of this Educational was accomplished only through the destruction of a prior organization and the marginalization of the structure of educational possibilities it presented. Education was certainly not synonymous with state schooling in the 1830s and 1840s. That we often equate the two today is another accomplishment of the Educational State (Curtis 1988, 15). That these words were synonymous in the eyes of the government in relation to education for Aboriginal people is apparent in the wording of treaties. For example, Treaties number Three, Five, and Six contain the promise that Her Majesty agrees to maintain schools (Charleston 1988, 1). Treaties number Two, Four, Eight, and Nine all contain similar wording regarding either the maintenance of or the provision of teachers. While Aboriginal people have interpreted these treaties to mean that they will be provided with education, the government has interpreted them to mean Aboriginal people will be provided with schooling. Post-contact First Nations schooling was based on religious and public schooling ideas that were imported from Anglo and French traditions--everything from the design of the school day, to the Eurocentric emphasis on the content of the curriculum, to the theories and practice of learning, curriculum development, and assessment (Calliou 1999, 175). Although Aboriginal people, and Canad ians in general, have now recognized the fact that schooling has had devastating effects on Aboriginal people, the design of the school day, a flaw Calliou has pointed Out, receives little attention. Instead the focus of those interested in self-determination in education is focused on First Nations' control over those school days, Aboriginal curriculum, and Aboriginal institutions. …

Development of a Home-Based Family Caregiver Cancer Education Program

Development of a Home-Based Family Caregiver Cancer Education Program

The Educational Benefits of a Ten-Week Home-Based Wild Bird Feeding Program for Children

ABSTRACTThis study evaluated a ten-week educational home-based program for feeding wild birds, intended to increase elementary school age children's knowledge about birds, especially those wild birds commonly encountered at outdoor home feeders. We measured changes from pre- to post-program in 65 seven- to 12-year old children's knowledge about wild birds, as well as in environmental attitudes. The goal was not only to increase bird knowledge in the target child but also to involve other family members in home-based nature education activities. After the program, seven- to nine-year old boys and girls showed significant gains in bird knowledge, but older children (10–12 years) did not significantly improve. Children's increased knowledge was positively associated with parental education. There was no systematic change in environmental attitudes. Parents identified family involvement as a particularly beneficial aspect of the program, and 90% of contacted families were still feeding birds one year after program termination.

Parental Knowledge, Attitude and Practice of Family Life: Education in Apata Town of Ibadan, Nigeria

It has been noted that many adolescent-focused programs in Nigeria have not been successful because they lack parental support. Yet no attempt has been made to examine what the parents know about family life education. The process of imparting both factual knowledge about human development sexual relationships preparation for parenthood pregnancy contraception and sexually transmitted infections and also values is called family life education. Though experts agree that the home is the best place to begin family life instruction parents themselves are sometimes reluctant and uncomfortable as discussion of these topics may be embarrassing or even a taboo to them. They may not be knowledgeable about family life education. The authors carried out this descriptive and exploratory study to investigate the perception and attitudes of parents to family life issues and education in a Nigerian suburban community. The results show that: of the 200 families interviewed 74% have heard of family life education; their personal interpretation of family life education is right; 92% believe the youths need guidance and counseling on sexual matters; 58% have ever discussed family life issues and mostly on menstruation and 77% believed parents are the best family educators. The major causes of premarital sex are ignorance and lack of information. The majority of the parents do not believe that sex education will lead to sexual promiscuity. Many also indicated their willingness to participate in a sex education program for parents to improve their capacity to deliver home-based family life education. Policy and research implications of the study are discussed. (authors modified)

Can Asthma Education Improve Clinical Outcomes? An Evaluation of a Pediatric Asthma Education Program

Asthma is a common, costly, and chronic disease that has a significant impact on children, their families, and the health care system. This study investigated whether formal asthma education can reduce asthma severity and morbidity and further questioned whether the method of education is an important factor in this process. Study subjects were recruited from the emergency department of the Royal Children's Hospital, Melbourne (RCHM), and controls were recruited from the neighboring Western Hospital, Sunshine (WHS). Subject parents were randomized to receive face-to-face education, group education, or home-based video education. Controls had similar medical treatment but received no formal asthma education. Subject and control parents were asked to complete questionnaires before the intervention and at 1, 6, and 12 months. These questionnaires measured demographics, the levels of parent asthma knowledge, anxiety, child asthma severity, and morbidity. Results showed that any method of education increased parent asthma knowledge and immediately decreased their anxiety and child asthma morbidity scores. Despite this, asthma severity was reduced only when knowledge was imparted in an interactive, face-to-face setting. When this happened, asthma severity scores were significantly reduced in both the short- and long-term. These findings call into question mass asthma education campaigns and have important implications for the design of future asthma education programs.

Development of a Home-Based Family Caregiver Cancer Education Program

This article describes a home-based educational program developed specifically for family caregivers of cancer patients who receive hospice and home care. The overall aim of this educational program is to specifically address family caregivers' needs for acquisition of necessary knowledge and skills to meet the physical and psychosocial demands associated with caring for a patient with advanced cancer. Originally, components of this program were offered in a small group discussion format within hospital and community settings. The educational program was transformed to accommodate the unique needs and constraints of homebound family caregivers who have very limited time and/or opportunities for support and education outside of the home. The program is comprised of educational modules that provide hospice and home care professionals with written and audiovisual materials designed to facilitate brief, structured, educational encounters with family caregivers in the home setting. Two hundred thirty-seven educational module kits were distributed to professionals affiliated with twenty-four home care and hospice agencies in the Greater Philadelphia area. Results of a telephone survey designed to elicit evaluation data from professional staff members who had used the educational modules are presented. Limitations, plans for future program evaluation, cost implications, and implementation recommendations related to this educational program are described.