Evaluation of a School-based Program Targeting Pediatric Asthma Self-management Skills in an Urban Population


Book Description

Asthma is the most commonly diagnosed chronic disorder in childhood and is linked with several problematic outcomes including frequent school absences, increased hospitalizations and decreased quality of life. Further, urban populations struggling with low socioeconomic status are disproportionately represented in prevalence statistics and suffer from increased functional morbidity relative to other children with asthma. These findings exist in the midst of largely effective pharmacological interventions. Asthma self-management programs (SMPs) target several behaviors linked to improved outcomes and are often used as an adjunct to medication management. SMPs have been employed using a variety of techniques and treatment targets in a wide range of settings. Data suggests that SMPs have a mild to moderate impact on functional morbidity outcomes and merit further research. In order to facilitate efficacious interventions to those at highest risk of problematic outcomes, common barriers impinging on program attendance must be alleviated. The school setting proves to be an ideal location to deliver SMPs due to their accessibility and available resources. The current project evaluates a school-based asthma SMP delivered in an urban setting. Results reveal statistically significant increases in quality of life and child reported knowledge as well as decreased utilization of urgent care outpatient treatment. Trends towards decreased agreement between children and caregivers on allocation of asthma management tasks reflect challenges with implementation of programs in the absence of frequent parental contact. School-based asthma SMPs afford several benefits to high-risk populations but also must reflect the need for family involvement in successful asthma management.
















Evaluation of a Web-enabled Interactive Multimedia Pediatric Asthma Education Program


Book Description

Introduction . Asthma is a chronic disease that affects millions of children. Many asthma education programs have been developed and evaluated. However, no Internet-enabled, asthma education program had been evaluated in a randomized controlled trial. This study investigated the effects of an Internet-enabled interactive multimedia asthma education program on asthma knowledge of children and their caregivers, on children's health outcomes and their use of health care resources. Methods . Two hundred and twenty-eight asthmatic children visiting a pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received conventional verbal and printed information about asthma. Intervention group participants received additional asthma education through the Interactive Multimedia Program for Asthma Control & Tracking (IMPACT©). Knowledge, symptom history, resource utilization, and quality of life data were collected at the initial visit and at 3- and 12-month intervals. Results . Analysis of knowledge scores using one-group Student's t-tests showed a significant improvement in disease specific knowledge about asthma and its management between the initial visit and the 12-month follow-up visit among the three groups: caregivers of children 0-6 years old, caregivers of children 7-17 years old and children 7-17 years old. Comparison of control and intervention groups using the Cochran-Mantel-Haenszel statistic revealed significantly higher knowledge gains in the intervention groups among caregivers of children 0-6 years old (p = .0085) and 7-17 years old (p = .0073), and among children 7-17 years old (p = .0006). The intervention group children experienced fewer days of asthma symptoms (p = .0099), fewer emergency room visits (p = .0243), and a decreased daily dose of inhaled corticosteroids (p = .0069). Knowledge scores for children 7-17 years old correlated with fewer urgent physician visits (r = 0.37, p = .011) and less frequent use of quick-relief medicines (r = 0.30, p = .043). However, the two groups did not significantly differ in the frequency of quick relief medicine use, the days of activity limitation, the nights of disturbed sleep, the number of urgent visits to physicians, the number of hospitalizations due to asthma, the days of stay in hospital for all hospitalizations, the number of school days missed, the asthma related quality of life and in the Pulmonary Function Test measures. Conclusions . The Interactive Multimedia Program for Asthma Control & Tracking (IMPACT©) is effective in improving asthma knowledge of asthmatic children and their caregivers and in improving health of asthmatic children.







Impact of a Self-Management Education on Health Outcomes and Quality of Life in Child Asthma


Book Description

According to the National Center for Health Statistics (2001) in 1998, 3.8 million children aged 0-17 years had an asthmatic episode. Nationally the asthma population is 6.3%. Arizona has exceeded the national asthma rates for 1991-1998 with an incidence of approximately 7% of the population. Asthmatic children require self-management instruction about asthma, medications, symptoms, and proper self-management. Poor self-management results from a lack of competence over asthma related self-management skills. This study defined self-management skill as those skills an asthmatic must have for competence in management. The purpose of this study was to test a self- management education program designed to enhance the self-management skill of inner city children with asthma in order to improve their health outcomes and quality of life. Measurement of effect in health outcomes and quality of life (QOL) were the indicators of competency in self-management skill. The pediatric asthma-specific questionnaire by Juniper and Guyatt (2001) examines QOL. Thurber and Blue (1994) developed the Asthma Self-care questionnaire to measure health outcomes. The pilot study design utilized a quasi-experimental design with pretest/posttest and non random assignment of subjects measured the differences in health outcomes and QOL of asthmatic children. Data collection was at three inner city Phoenix public schools. The analysis examined the * independent variable influence of self-management education on the dependent variable impact on quality of life and health outcomes.




Achieving Asthma Control in Pediatric Patients


Book Description

"Many parents of children diagnosed with asthma fail to understand the multitude of complexities in controlling and preventing asthma exacerbations, resulting in increased mortality, morbidity, and health care cost. National and international guidelines state that the aim of an asthma self-management program is to achieve and maintain asthma control (National Asthma Education Prevention Program [NAEPP], 2007). The purpose of an evidence-based practice project referred to as the Parent Asthma Education Program was to educate parents of children, ages 5 to 12 diagnosed with moderate and severe persistent asthma and using the Medicaid system to improve the child's quality of life and functional of the family and decreased unscheduled health care utilization. The Parent Asthma Education Program was based on the National Asthma Education Prevention Program, Expert Panel Report-3 Guidelines. The Children's Health Survey for Asthma (CHSA), a condition-specific, self-reported, functional validated health measure for parents/caregivers of children five to 12 years of age with chronic asthma was administered before and after the educational program. The project showed a decrease in unscheduled medical utilization after parents attended the asthma education program. The results of this project demonstrated asthma education targeting parent specific objectives increased quality of life, increased the capacity to function in normal social roles, and decreased health care costs." -- Abstract.