The impact of health education on frequency and cost of health care use by low income children with asthma

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

The public health benefits of research can be realized only if proven new techniques are translated into readily usable processes and materials and widely adopted by professionals and patients alike. To accomplish this, a systematic technology transfer process is needed. One recent outcome of health behavior research has been identification of the skills needed by children and parents to effectively manage childhood asthma. Methods for teaching these skills were tested on hundreds of families in a variety of health care settings. They were then packaged in program manuals that guide health professionals through the teaching process and provide all necessary materials for conducting sessions. The resulting four programs teach attack prevention and control skills. They also emphasize coping skills and help families come to terms with the behavioral factors that impinge on asthma management and affect compliance with medical advice. A technology transfer project for getting initial community adoption of these programs is described. The evolution of the project, including the development of the programs themselves, packaging considerations, establishment of a unique partnership for dissemination, development of a model workshop for stimulating health professionals, implementation of programs, and follow up and evaluation, is described. Successful elements are identified at each step.

ACT-asthma control y tratamiento para niños: a progress report

A randomized clinical trial is in progress to evaluate an asthma educational program for Latino children and their parents. The intervention, "ACT-Asma Control y Tratamiento Para Niños," was adapted from ACT for Kids, an asthma self-management program for English-speaking families. Results of a pilot study indicated that socioeconomic status was a critical variable to be considered in the design of such programs. Latino children and parents encounter significant barriers to access and continuity of medical care. Therefore, the intervention was redesigned to include "linkages" using a nurse to reduce barriers and to coordinate care. The lesson plans emphasize concrete, experimental learning experiences, with repetition of key points in each session.

A school health education program for children with asthma aged 8-11 years

It was hypothesized that a health education program for children with asthma aged 8-11 years that was delivered in elementary schools, would increase children's asthma management skills, self-efficacy and influence on parents' management decisions; reduce school absences and improve school performance. The study population consisted of 239 low-income, predominantly Hispanic and black children from 12 elementary schools (six experimental and six control) in New York City. Parents did not attend educational sessions but received written materials. The program emphasized the child's responsibility for recognizing symptoms and taking appropriate management steps. Follow-up data obtained one year after the program showed that compared to controls experimental group children had higher scores on an index of asthma management (p less than 0.05), greater self-efficacy with respect to asthma management skills (p less than 0.05), more influence on parents' asthma management decisions (p less than 0.05), better grades in school (p = 0.05), and fewer episodes of asthma (p less than 0.01) of shorter average duration (p less than 0.01). No differences were observed for changes in number of school absences. These findings show that asthma health education designed for delivery to children can significantly increase management skills, reduce symptoms of asthma, and improve school performance.

Managing better: children, parents, and asthma

To evaluate a health education program to improve family management of asthma, 310 children with asthma and their 290 parents were randomly assigned to a program or control group. Program families participated in health education designed to resolve specific management problems and build self-confidence in the ability to manage asthma. Following education, program parents scored better on an asthma self-management index than parents in the control group (+1.57 versus -0.83, P less than 0.0001). Program parents also scored better on two subindices of the self-management index: attack management (+0.87 vs. +0.42, P less than 0.05) and preventive measures (+0.42 vs. -0.35, P less than 0.05). Also, program parents reported significantly more use of guidelines to determine appropriate levels of physical activity for children. Following education, program children reported more use of three management steps than control children: productive cough or postural drainage (59% vs. 35%, P less than 0.004), breathing and relaxation exercises (80% vs. 65%, P less than 0.05), and attempts to stay calm (12% vs. 2%, P less than 0.05). Program children reported significantly less worry than control children about the limitations asthma imposes and about making mistakes at school.