School-based Asthma Education Program Research Articles

Student knowledge gains among first-time and repeat attendees of school-based asthma education program

BackgroundBecause children spend much of their time in schools, schools can play an important role in asthma education for the one in 12 affected children in the United States. School-based asthma education programs are commonly repeated annually, however few studies have evaluated the impact of repeated participation in asthma education in school-based programs.MethodsThis observational study evaluated the impact of Fight Asthma Now© (FAN), a school-based asthma education program for children in Illinois schools. Participants completed a survey at the start and end of the program, including demographics, prior asthma education, and 11 asthma knowledge questions (maximum knowledge score = 11).ResultsAmong 4,951 youth participating in the school-based asthma education program, mean age was 10.75 years. Approximately half were male and Black. Over half reported no prior asthma education (54.6%). At baseline, repeat attendees had significantly higher knowledge versus first-time attendees (mean: 7.45 versus 5.92; p < 0.001). After the program, both first-time and repeat attendees had significant knowledge improvements (first-time: mean = 5.92◊9.32; p < 0.001; repeat: mean = 7.45◊9.62; p < 0.001).ConclusionsSchool-based asthma education is effective for increasing asthma knowledge. Notably, repeated asthma education in school leads to incremental benefits for knowledge. Future studies are needed to understand the effects of repeated asthma education on morbidity.

Results of an asthma education program delivered via telemedicine in rural schools

BackgroundAsthma morbidity is high in low-income children living in rural US regions, yet few interventions have been designed to decrease the asthma burden in rural populations. ObjectiveTo examine the effect of a school-based asthma education program delivered by telemedicine in children living in an impoverished rural region. MethodsWe conducted a cluster randomized trial with rural children 7 to 14 years old by comparing a school-based telemedicine asthma education intervention with usual care. The intervention provided comprehensive asthma education by telemedicine to participants and provided evidence-based treatment recommendations to primary care providers. ResultsOf the 393 enrolled children, median age was 9.6 years, 81% were African American, and 47% lived in households with an annual income less than $14,999. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom-free days (primary outcome) for the intervention or usual-care group. Participants in the intervention group reported significantly higher use of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently compared with the usual-care group. There were no changes in other outcome measures, including quality of life, self-efficacy, asthma knowledge, or lung function, between groups. ConclusionAlthough there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers, and inadequate access to asthma providers in rural regions. Trial RegistrationClinicalTrials.gov Identifier: NCT01167855.

A systematic review of school-based interventions that include inhaler technique education

Proper use of inhaled medication is essential for the successful treatment of childhood asthma; yet, improper inhaler technique among school-aged children is common. There are many schoolbased asthma education programs, but the extent to which these programs teach inhaler technique is unknown. We systematically reviewed the literature to identify schoolbased asthma interventions that included inhaler technique instruction. We searched several databases, including PubMed, for relevant articles. Studies were included if they were asthma interventions of any type (programs, curriculums, education) conducted at kindergarten through twelfth grade schools that taught inhaler technique and included inhaler technique as an outcome measure. Of the 285 citations identified, the final nine studies (selected from 71 full-text articles) met the inclusion criteria. Findings from this systematic review identified a very small number of school-based interventions that evaluated improvements in students' inhaler technique. Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique instruction varied in length, from 15min to 1h and nurses implemented inhaler technique instruction in six of the nine (67%) interventions. Existing studies offer mixed evidence for sustained technique improvements up to a 12-month follow-up period. Evidence suggests that students benefit from school-based inhaler technique education; however, inconsistencies in how technique was measured limit our ability to draw firm conclusions regarding the effectiveness of inhaler technique education on student outcomes. Future studies are needed to identify the most appropriate and feasible inhaler technique education components for use in comprehensive asthma self management interventions.

Improving School Attendance through Asthma Education: A Systematic Literature Review of School-Based Asthma Education Programs

Improving School Attendance through Asthma Education: A Systematic Literature Review of School-Based Asthma Education Programs

The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the best available quantitative evidence related to the effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to18 years with a diagnosis of asthma. INCLUSION CRITERIA Types of participants This review will consider studies that include children, five to 18 years of age, of any gender, race, or ethnicity with a clinical diagnosis of asthma, who has participated in school-based asthma education programs that include their caregivers. Studies that include children younger than age five and older than age 18, with respiratory diseases other than asthma, who have not participated in school-based asthma education programs that include their caregivers will be excluded. Types of intervention(s) This review will consider studies that evaluate the effectiveness of school-based family asthma education interventions on the quality of life and number of asthma exacerbations of children with asthma compared to absence of school-based family asthma education programs. Types of outcomes This review will consider studies that include the following outcome measures: primary outcomes of quality of life and asthma exacerbations, and secondary outcomes of absences from school or work, physical activity intolerance, and emergency hospital visits as a result of asthma exacerbations. Quality of life can be measured by a valid and reliable tool such as the Pediatric Asthma Quality of Life Questionnaire. The number of asthma exacerbations can be measured by valid and reliable tools such as the TRUNCATED AT 250 WORDS

Reducing Health Disparities For Asthma With a School Based Asthma Education Program

Reducing Health Disparities For Asthma With a School Based Asthma Education Program

“The Roaring Adventures of Puff” (RAP) – a school based asthma education program for children with asthma

Background Asthma guidelines recognize asthma education as “an essential component of asthma therapy”. The Children’s Asthma Education Centre (CAEC)’s small group interactive sessions for children and families does not meet the needs of all families. Schools provide an opportunity for asthma education. The “Roaring Adventures of Puff” (RAP) is an effective, previously validated asthma education program.

Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers

School-based asthma education programs targeting disadvantaged youth and teens with asthma are lacking. To assess the impact of the Fight Asthma Now (FAN) educational program among 2 populations of predominantly low-income minority students: youth (3(rd)-6(th) graders) and teens (7(th)-8(th) graders). Chicago-area elementary schools were invited to participate in this stratified 2-arm study. Eligible schools were assigned to participate either in the intervention or in the control arm. Within each participating school, eligible students were recruited and grouped (stratified by grade and age) to form teen or youth classes. Participants completed a pre- and post-intervention asthma knowledge questionnaire and observation for spacer technique competency. The treatment group received the FAN curriculum between the evaluations. A sample of 26 low-income, predominantly minority-serving schools was recruited. Most participating schools were randomized in a 3:1 ratio to form 25 youth classes (19 intervention and 6 control group) and 16 teen classes (11 intervention and 5 control group), resulting in 275 vs 69 youth and 141 vs 51 teens in the intervention and control groups, respectively. Stratified analyses were performed, and clustering within the school and class was taken into consideration in analyses. Multilevel models adjusting for school, class, ethnicity, sex, and pretest score indicate that the FAN intervention significantly increased both knowledge and spacer competency test scores, among both the youth and teen participants (P = .011 with respect to knowledge score among teen students, P < .0001 for all other cases). This study suggests that FAN significantly increases asthma knowledge and spacer technique competency within this high-risk population.

The Effects of Self-Management Education for School-Age Children on Asthma Morbidity

The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and targeted children 5-18 years of age were reviewed. The studies were all published between 1998 and 2009. The school-based asthma education programs delivered interventions in multiple sessions over short consecutive time periods of about a month to a month and a half. Follow-up data were collected in varying intervals from 1 month to 1 year postinterventions. Results indicated that a decrease in school days missed can be expected from such programs. The data regarding emergency department visits and hospital admissions was less definitive.

Knowledge and Attitudes of Adolescents towards Asthma: Questionnaire Results before and after a School-Based Education Program

Background: Previous studies on school-based education programs have reported that asthmatic and nonasthmatic adolescents, teachers and school personnel do not have enough information on asthma. However, the number of education programs including adolescents without asthma is not sufficient. The aim of the present study was to determine the knowledge of school children about asthma and to investigate whether their knowledge of asthma can be increased by an education program through a booklet distributed as a handout. Methods: This cross-sectional prospective questionnaire survey was carried out in a private school in Ankara, Turkey, between February and April 2006. 720 adolescents in grades 6, 7 and 8 were included. Knowledge about asthma was evaluated by a scoring system before and after the education offered by means of a booklet. Results: The final analysis was conducted on 642 students in total. The number of right answers in 5 categories, percentage of right answers and total questionnaire score improved significantly after the education received (p < 0.001). The total questionnaire scores of the girls (p = 0.002), those students with a university graduate mother (p = 0.006) and those with a physician parent (p = 0.041) were higher than those of the other pupils. Conclusion: Theoretical material in the form of a booklet can be used in a school-based asthma education program in order to improve the knowledge of adolescents about asthma.

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p < 0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity.

Do School-Based Asthma Education Programs Improve Self-Management and Health Outcomes?

Asthma self-management education is critical for high-quality asthma care for children. A number of studies have assessed the effectiveness of providing asthma education in schools to augment education provided by primary care providers. To conduct a systematic review of the literature on school-based asthma education programs. As our data sources, we used 3 databases that index peer-reviewed literature: MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature. Inclusion criteria included publication in English and enrollment of children aged 4 to 17 years with a clinical diagnosis of asthma or symptoms consistent with asthma. Twenty-five articles met the inclusion criteria. Synthesizing findings across studies was difficult because the characteristics of interventions and target populations varied widely, as did the outcomes assessed. In addition, some studies had major methodologic weaknesses. Most studies that compared asthma education to usual care found that school-based asthma education improved knowledge of asthma (7 of 10 studies), self-efficacy (6 of 8 studies), and self-management behaviors (7 of 8 studies). Fewer studies reported favorable effects on quality of life (4 of 8 studies), days of symptoms (5 of 11 studies), nights with symptoms (2 of 4 studies), and school absences (5 of 17 studies). Although findings regarding effects of school-based asthma education programs on quality of life, school absences, and days and nights with symptoms were not consistent, our analyses suggest that school-based asthma education improves knowledge of asthma, self-efficacy, and self-management behaviors.

Garnering Administrative Support for School-Based Asthma Education Programs

Garnering Administrative Support for School-Based Asthma Education Programs

Asthma Education for Rural School Nurses: Resources, Barriers, and Outcomes

This paper describes a school-based asthma education program for rural elementary school nurses. The program was designed to teach school nurses in 7 rural counties in Maryland how to implement and to reinforce asthma management behaviors in children with asthma and their caregivers. Rural nurses who participated in this program increased their mean asthma knowledge scores more than nurses who did not take the program. The program also increased self-efficacy among intervention school nurses, but the difference in self-efficacy between intervention and control nurses was not statistically significant at follow-up. No effects on documentation or communication behaviors were noted. Only 25% of the nurses reported an interest in implementing future asthma educational programs for children with asthma. This study indicates the importance of understanding the unique characteristics of rural school nurses, the resources they need, and the barriers and challenges they face in their practice.

Asthma Education for Rural School Nurses: Resources, Barriers, and Outcomes

This paper describes a school-based asthma education program for rural elementary school nurses. The program was designed to teach school nurses in 7 rural counties in Maryland how to implement and to reinforce asthma management behaviors in children with asthma and their caregivers. Rural nurses who participated in this program increased their mean asthma knowledge scores more than nurses who did not take the program. The program also increased self-efficacy among intervention school nurses, but the difference in self-efficacy between intervention and control nurses was not statistically significant at follow-up. No effects on documentation or communication behaviors were noted. Only 25% of the nurses reported an interest in implementing future asthma educational programs for children with asthma. This study indicates the importance of understanding the unique characteristics of rural school nurses, the resources they need, and the barriers and challenges they face in their practice.

School-based asthma education program and impact on quality of life

RATIONALE: Improving child and caregiver quality of life is a common goal of asthma education programs, but few studies have evaluated the quality of life of both groups independently. We assessed the impact of a school-based asthma education program on child and caregiver quality of life.

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.

The effects of a school-based intervention on the self-care and health of African-American inner-city children with asthma

Asthma is a chronic illness that affects 5% to 10% or about 5 million children in this country. Morbidity and rising mortality rates are of particular concern in minority children. This study addresses a serious knowledge deficit about the management of asthma in minority children by testing the effect of a school-based asthma education program on psychosocial and health outcomes of 8–13-year-old inner-city minority students. Although the mean scores of the treatment group were higher than the control group on several of the psychosocial measures, these changes were not significant. However, significant differences were found between the groups on health outcomes. Recommendations for future research and clinical practice are discussed.

Methods and issues in conducting a community-based environmental randomized trial*1

The environment is suspected to play an important role in the prevalence and severity of asthma in inner-city children. This paper describes the implementation and baseline data of an inner-city community-based participatory research clinical trial designed to test the effectiveness of a pollutant and allergen control strategy on children's asthma morbidity. Participants were 100 elementary-school-aged children with asthma, graduates of a school-based asthma education program in East Baltimore. The intervention for half of the randomly assigned families consisted of environmental control education, allergen-proof encasements, pest extermination, and a HEPA air cleaner at the beginning of the study. Controls received the same at the end of the study. Participants visited a clinic for questionnaires, allergy skin testing, spirometry, and blood sample at baseline and 12 months. Home environments, NO2, O3, airborne particulates, and allergens were evaluated at baseline and at 6 and 12 months. Asthma morbidity and adherence was assessed quarterly. Collaboration with the community proved very beneficial in creating a study design and procedures acceptable to an inner-city community.

Methods and issues in conducting a community-based environmental randomized trial

The environment is suspected to play an important role in the prevalence and severity of asthma in inner-city children. This paper describes the implementation and baseline data of an inner-city community-based participatory research clinical trial designed to test the effectiveness of a pollutant and allergen control strategy on children's asthma morbidity. Participants were 100 elementary-school-aged children with asthma, graduates of a school-based asthma education program in East Baltimore. The intervention for half of the randomly assigned families consisted of environmental control education, allergen-proof encasements, pest extermination, and a HEPA air cleaner at the beginning of the study. Controls received the same at the end of the study. Participants visited a clinic for questionnaires, allergy skin testing, spirometry, and blood sample at baseline and 12 months. Home environments, NO 2, O 3, airborne particulates, and allergens were evaluated at baseline and at 6 and 12 months. Asthma morbidity and adherence was assessed quarterly. Collaboration with the community proved very beneficial in creating a study design and procedures acceptable to an inner-city community.