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Alshaikhi SA, Alamri AM, Alzilai IY, Alghanimi AA, Alrufaidi AM, Alrufaidi AM, Bader AE, Abdelmoniem AA, Alshaikh AA, Alshaikhi OA, Alshaikhi MA, Ghazy RM. Diabetes and prediabetes prevalence through a community-based screening initiative in Alqunfudah, Saudi Arabia. Future Sci OA 2024; 10:FSO946. [PMID: 38817391 PMCID: PMC11137795 DOI: 10.2144/fsoa-2023-0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 06/01/2024] Open
Abstract
Aim: This study aimed to identify prediabetic and diabetic patients using fasting blood sugar in Alqunfudah, Saudi Arabia. Patients & methods: Multistage stratified random sampling technique was used to recruit study participants aged 18 years and older. We measured anthropometric measures like waist circumference and body mass index. Results: A total of 332 participants were included in this study, 52.4% were female, 45.2% aged >50 years, 89.8% were Saudi, and 19.0% had been diagnosed with hypertension. Nearly a third (36.1%) of the participants were diagnosed with Type 2 diabetes mellitus and 28.3% had impaired fasting glucose. Age and hypertension were significant predictors of diabetes. Conclusion: Early detection and intervention are crucial to reducing the diabetes epidemic in Saudi Arabia.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ayoub Ali Alshaikh
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | - Ramy Mohamed Ghazy
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt
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2
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052539. [PMID: 35270232 PMCID: PMC8909612 DOI: 10.3390/ijerph19052539] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023]
Abstract
Mothers’ knowledge about childhood asthma influences management practices and disease control, but validating knowledge/practice questionnaires is difficult due to the lack of a gold standard. We hypothesized that Latent Class Analysis (LCA) could help identify underlying mother profiles with similar knowledge/practices. A total of 438 mothers of asthmatic children answered a knowledge/practice questionnaire. Using answers to the knowledge/practice questionnaire as manifest variables, LCA identified two classes: Class 1, “poor knowledge” (33%); Class 2, “good knowledge” (67%). Classification accuracy was 0.96. Mothers in Class 2 were more likely to be aware of asthma-worsening factors and indicators of attacks. Mothers in Class 1 were more likely to prevent exposure to tobacco smoke (91.1% vs. 78.8%, p = 0.005). For attacks, mothers in Class 2 were more likely to go to the emergency department and follow the asthma action plan. Mothers in Class 2 more frequently had a high education level (79.5% vs. 65.2%, p = 0.004). Children in Class 2 more frequently had fully controlled asthma (36.7% vs. 25.9%, p = 0.015) and hospitalizations for attacks in the previous 12 months (24.2% vs. 10.7%, p = 0.003). LCA can help discover underlying mother profiles and plan targeted educational interventions.
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Tyris J, Keller S, Parikh K. Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e215103. [PMID: 34870710 PMCID: PMC8649910 DOI: 10.1001/jamapediatrics.2021.5103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes among children is unclear. OBJECTIVE To catalog asthma interventions by the social risks they address and synthesize their associations with asthma-related emergency department (ED) visits and hospitalizations among children. DATA SOURCES PubMed, Scopus, PsycINFO, SocINDEX, CINAHL, and references of included full-text articles were searched from January 1, 2008, to June 16, 2021. STUDY SELECTION Included articles were US-based studies evaluating the associations of interventions addressing 1 or more social risks with asthma-related ED visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%). DATA EXTRACTION AND SYNTHESIS Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The SDOH intervention clusters were identified by grouping studies according to the social risks they addressed, using the Healthy People 2020 SDOH framework. Random-effects models created pooled risk ratios (RRs) as the effect estimates. MAIN OUTCOMES AND MEASURES Patients with ED visits or hospitalizations were the primary outcomes. Subgroup analyses were conducted by an SDOH intervention cluster. Sensitivity analyses were conducted for each, removing outlier studies and studies failing to meet the minimum quality threshold. RESULTS In total, 38 studies were included in the systematic review, with 19 of these studies providing data for the meta-analysis (5441 participants). All interventions addressed 1 or more of the health, environment, and community domains; no interventions focused on the economy or education domains. In the primary analysis, social risk interventions were associated with decreased ED visits (RR, 0.68; 95% CI, 0.57-0.81; I2 = 70%) and hospitalizations (RR, 0.50; 95% CI, 0.37-0.68; I2 = 69%). In subgroup analyses, the health, environment, and community intervention cluster produced the lowest RR for ED visits (RR, 0.53; 95% CI, 0.44-0.64; I2 = 50%) and for hospitalizations (RR, 0.33; 95% CI, 0.20-0.55; I2 = 71%) compared with other intervention clusters. Sensitivity analyses did not alter primary or subgroup effect estimates. CONCLUSIONS AND RELEVANCE The results of this systematic review and meta-analysis indicate that social risk interventions are associated with decreased asthma-related ED visits and hospitalizations among children. These findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Susan Keller
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC,George Washington University School of Medicine and Health Sciences, Washington, DC
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Divecha CA, Tullu MS, Jadhav DU. Parental knowledge and attitudes regarding asthma in their children: Impact of an educational intervention in an Indian population. Pediatr Pulmonol 2020; 55:607-615. [PMID: 31962003 DOI: 10.1002/ppul.24647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/05/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Research shows positive effects of asthma education in improving parental knowledge, self-management skills, and reducing healthcare costs. Such studies are lacking in resource-limited countries. We studied the effectiveness of educational intervention in improving the knowledge and attitudes of parents/caregivers of asthmatic children. METHODS The study was conducted in the pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into the interventional group (A) receiving education module and control group (B). Parents' asthma knowledge and attitudes were assessed at baseline and 5 months postenrollment using 25-item questionnaire. Detailed demographic data, clinical data, and exacerbations during study were noted. RESULTS A total of 75 parents/guardians fulfilling inclusion criteria were analyzed (cases/group A: 37 and controls/group B: 38). 8.3 percent of parents/caregivers were illiterate. Around 36.9% of patients had a family history of allergy/asthma. Mean knowledge scores at follow-up were 12.24 and 9.89 for groups A and B, respectively (P < .05). Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma, and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude-based questions postintervention as compared with the nonintervention group (B). There was no statistically significant difference in asthma severity and control between the two groups at follow-up. CONCLUSIONS Small group education on asthma in parents/caregivers improves their knowledge and attitudes. Healthcare plans should invest in pediatric asthma education and identify key personnel/opportunities to impart the same in routine care.
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Affiliation(s)
- Chhaya A Divecha
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Devika U Jadhav
- Department of Pediatrics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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McClure N, Seibert M, Johnson T, Kannenberg L, Brown T, Lutenbacher M. Improving Asthma Management in the Elementary School Setting: An Education and Self-management Pilot Project. J Pediatr Nurs 2018; 42:16-20. [PMID: 30219294 DOI: 10.1016/j.pedn.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To increase daily asthma symptom self-assessments of elementary school students using Green Means Go, an asthma education and self-assessment program, via a partnership between an elementary school and a school of nursing. METHODS Over four months, accelerated MSN nursing students provided small group education sessions to teach students and teachers to identify asthma symptoms by Asthma Action Plan (AAP) zones and actions for each zone. To promote continuity of care between school and home, a teacher-parent communication log during yellow zone days was encouraged. RESULTS Students with asthma (n = 90), teachers (n = 12) and parents (n = 1) participated. Previously no students performed daily self-assessments and at program end, all students accurately identified symptoms, AAP zones, and action steps. A total of 789 symptom self-assessments were recorded. Teachers reported increased asthma knowledge. One parent attended an education session and one home visit was completed. No communication logs were returned. CONCLUSIONS Partnerships between elementary and nursing schools may be an effective strategy for delivery of health programs to high-risk children with chronic diseases. Self-assessment of symptoms and taking appropriate actions at school are critical components of early asthma intervention, particularly when a school nurse is not always available. Training teachers to follow a child's AAP within school policies is a critical second step. Home visits showed potential as a strategy for engaging parents. PRACTICE IMPLICATIONS In the current climate of school nurse shortages, management of asthma-related episodes in school can be improved with similar partnerships and programs that promote health education and self-management.
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Affiliation(s)
- Natasha McClure
- Vanderbilt University School of Nursing, Nashville, TN, USA.
| | | | - Taylor Johnson
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | | | - Trey Brown
- Vanderbilt University School of Nursing, Nashville, TN, USA
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Ruvalcaba E, Chung SE, Rand C, Riekert KA, Eakin M. Evaluating the implementation of a multicomponent asthma education program for Head Start staff. J Asthma 2018. [PMID: 29543493 DOI: 10.1080/02770903.2018.1443467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Asthma disproportionately affects minority groups, low income populations, and young children under 5. Head Start (HS) programs predominantly serve this high-risk population, yet staff are not trained on asthma management. The objective of this study was to assess a 5-year, multicomponent HS staff asthma education program in Baltimore City HS programs. METHODS All HS programs were offered annual staff asthma education by a medical research team that included didactic lectures and hands-on training. Attendees received continuing education credits. HS staff were anonymously surveyed on asthma knowledge and skills and asthma medication management practices in Year 1 (preimplementation) and Year 5. RESULTS There was an estimated response rate of 94% for Year 1 and 82% for Year 5. Compared to staff in Year 1, Year 5 staff were significantly more likely to report they had very good knowledge and skills related to asthma [odds ratio (OR) 1.63; p < 0.05] and were engaged in asthma care activities (OR 2.02; p < 0.05). Self-reported presence of asthma action plans for all children with asthma was 82% at Year 1 and increased to 89% in Year 5 (p = 0.064). CONCLUSIONS Year 5 HS staff reported higher self-assessed knowledge and skills, self-reports of asthma medication management practices, and self-reports of asthma activities compared to Year 1 staff. HS serves high-risk children with asthma, and a multicomponent program can adequately prepare staff to manage asthma in the child care setting. Our results indicate the feasibility of providing efficacious health skill education into child care provider training to reduce asthma knowledge gaps.
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Affiliation(s)
- Elizabeth Ruvalcaba
- a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Shang-En Chung
- a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Cynthia Rand
- a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Kristin A Riekert
- a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Michelle Eakin
- a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of Medicine , Baltimore , MD , USA
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Young CA, Stookey J, Patel AI, Chan C, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children. J Asthma 2016; 53:691-8. [PMID: 27164036 PMCID: PMC5814296 DOI: 10.3109/02770903.2015.1135944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/21/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. METHODS We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. RESULTS 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. DISCUSSION There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.
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Affiliation(s)
- Chelsea A. Young
- University of California, San Francisco, Department of Psychiatry, San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Anisha I. Patel
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Karen Cohn
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Luz Agana
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Irene H. Yen
- Internal Medicine, University of California, San Francisco
| | | | - Michael D. Cabana
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Kintner E, Cook G, Marti CN, Stoddard D, Gomes M, Harmon P, Van Egeren LA. Comparative Effectiveness on Cognitive Asthma Outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a Non-Academic Program. Res Nurs Health 2015; 38:423-35. [PMID: 26296595 PMCID: PMC5935115 DOI: 10.1002/nur.21678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/06/2022]
Abstract
Asthma morbidity and mortality is higher among older school-age children and early adolescents than other age groups across the lifespan. NIH recommended expanding asthma education to schools and community settings to meet cognitive outcomes that have an impact on morbidity and mortality. Guided by the acceptance of asthma model, an evidence-guided, comprehensive school-based academic health education and counseling program, Staying Healthy-Asthma Responsible & Prepared™ (SHARP), was developed. The program complements existing school curricula by integrating biology, psychology, and sociology content with related spelling, math, and reading and writing assignments. Feasibility, benefits, and efficacy have been established. We compared the effectiveness of SHARP to a non-academic program, Open Airways for Schools, in improving asthma knowledge and reasoning about symptom management. A two-group, cluster-randomized, single-blinded design was used with a sample of 205 students in grades 4-5 with asthma and their caregivers. Schools were matched prior to randomization. The unit of analysis was the student. Certified elementary school teachers delivered the programs during instructional time. Data were collected from student/caregiver dyads at baseline and at 1, 12, and 24 months after the intervention. In multilevel modeling, students enrolled in the academic SHARP program demonstrated significant (p< .001) improvement in asthma knowledge and reasoning over students enrolled in the non-academic program. Knowledge advantages were retained at 24 months. Findings support delivery in schools of the SHARP academic health education program for students with asthma.
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Affiliation(s)
- Eileen Kintner
- Associate Professor, School of Nursing, D0100, The University of Texas at Austin, 1700 Red River Street, NUR 3.446, Austin, TX 78701-1499
| | - Gwendolyn Cook
- Research Associate, Comparison of Asthma Programs for Schools, The University of Texas at Austin School of Nursing, Austin, TX
| | - C Nathan Marti
- Statistician, Division of Statistics and Scientific Computation, The University of Texas at Austin, Austin, TX
| | - Debbie Stoddard
- Site Coordinator, University Outreach and Engagement, Michigan State University, East Lansing, MI
| | - Melissa Gomes
- Licensed School Counselor, C. W. Otto Middle School, Lansing, MI
| | - Phyllis Harmon
- Administrative Research Assistant, Comparison of Asthma Programs for Schools, The University of Texas at Austin School of Nursing, Austin, TX
| | - Laurie A Van Egeren
- Director, Community Evaluation and Research Collaborative, Co-Director, National Collaborative for the Study of University Engagement, University Outreach and Engagement, Michigan State University, East Lansing, MI
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Pinnock H, Epiphaniou E, Pearce G, Parke H, Greenhalgh T, Sheikh A, Griffiths CJ, Taylor SJC. Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies. BMC Med 2015; 13:127. [PMID: 26032941 PMCID: PMC4465463 DOI: 10.1186/s12916-015-0361-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Asthma self-management remains poorly implemented in clinical practice despite overwhelming evidence of improved healthcare outcomes, reflected in guideline recommendations over three decades. To inform delivery in routine care, we synthesised evidence from implementation studies of self-management support interventions. METHODS We systematically searched eight electronic databases (1980 to 2012) and research registers, and performed snowball and manual searches for studies evaluating implementation of asthma self-management in routine practice. We included, and adapted systematic review methodology to reflect, a broad range of implementation study designs. We extracted data on study characteristics, process measures (for example, action plan ownership), asthma control (for example, patient reported control questionnaires, days off school/work, symptom-free days) and use of health services (for example, admissions, emergency department attendances, unscheduled consultations). We assessed quality using the validated Downs and Black checklist, and conducted a narrative synthesis informed by Kennedy's whole systems theoretical approach (considering patient, practitioner and organisational components and the interaction between these). RESULTS We included 18 studies (6 randomised trials, 2 quasi-experimental studies, 8 with historical controls and 3 with retrospective comparators) from primary, secondary, community and managed care settings serving a total estimated asthma population of 800,000 people in six countries. In these studies, targeting professionals (n = 2) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (n = 6) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organisation (n = 3) improved process measures, but had little/no effect on clinical outcomes. Interventions that explicitly addressed patient, professional and organisational factors (n = 7) showed the most consistent improvement in both process and clinical outcomes. Authors highlighted the importance of health system commitment, skills training for professionals, patient education programmes supported by regular reviews, and on-going evaluation of implementation effectiveness. CONCLUSIONS Our methodology offers an exemplar of reviews synthesising the heterogeneous implementation literature. Effective interventions combined active engagement of patients, with training and motivation of professionals embedded within an organisation in which self-management is valued. Healthcare managers should consider how they can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care. SYSTEMATIC REVIEW REGISTRATION PROSPERO (registration number: CRD42012002898 ) Accessed 24 May 2015.
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK.
| | - Gemma Pearce
- Centre for Technology Enabled Health, Coventry University, Coventry, CV1 5FB, UK.
| | - Hannah Parke
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK.
| | - Trish Greenhalgh
- Department of Primary Care Health Sciences, New Radcliffe House, 2nd floor, Walton Street, Oxford, OX2 6GG, UK.
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Stephanie J C Taylor
- Public Health and Primary Care, Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK.
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11
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Young CA, Chan C, Stookey J, Patel AI, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:121-128. [PMID: 26155370 DOI: 10.1089/ped.2014.0471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/29/2015] [Indexed: 11/13/2022]
Abstract
Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.
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Affiliation(s)
- Chelsea A Young
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Anisha I Patel
- Department of Pediatrics, University of California , San Francisco, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Karen Cohn
- Children's Environmental Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Luz Agana
- Children's Environmental Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Irene H Yen
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Alicia Fernandez
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Michael D Cabana
- Department of Pediatrics, University of California , San Francisco, San Francisco, California. ; Philip R. Lee Institute of Health Policy Studies, University of California , San Francisco, San Francisco, California. ; Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
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Riera A, Ocasio A, Tiyyagura G, Krumeich L, Ragins K, Thomas A, Trevino S, Vaca FE. Latino caregiver experiences with asthma health communication. QUALITATIVE HEALTH RESEARCH 2015; 25:16-26. [PMID: 25185159 DOI: 10.1177/1049732314549474] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.
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Affiliation(s)
| | - Agueda Ocasio
- Junta for Progressive Action, New Haven, Connecticut, USA
| | | | | | - Kyle Ragins
- Yale University, New Haven, Connecticut, USA
| | - Anita Thomas
- University of Washington, Seattle, Washington, USA
| | - Sandra Trevino
- Junta for Progressive Action, New Haven, Connecticut, USA
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Elliott JP, Marcotullio N, Skoner DP, Lunney P, Gentile DA. Impact of student pharmacist-delivered asthma education on child and caregiver knowledge. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2014; 78:188. [PMID: 25657375 PMCID: PMC4315210 DOI: 10.5688/ajpe7810188] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/05/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children. DESIGN Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps. ASSESSMENT Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (p<0.001). The education intervention, however, did not increase caregiver knowledge of asthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019). CONCLUSION The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers' knowledge of asthma is strongly correlated with better asthma control in their children.
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Taylor SJC, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, Purushotham N, Jacob S, Griffiths CJ, Greenhalgh T, Sheikh A. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02530] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Centre for Population Health Science, University of Edinburgh, Edinburgh, UK
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gemma Pearce
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Hannah L Parke
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Anna Schwappach
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Neetha Purushotham
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Sadhana Jacob
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Trisha Greenhalgh
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Centre for Population Health Science, University of Edinburgh, Edinburgh, UK
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Riera A, Ocasio A, Goncalves P, Krumeich L, Katz KH, Trevino S, Vaca FE. Findings from a community-based asthma education fair for Latino caregivers. J Asthma 2014; 52:71-80. [PMID: 25019349 DOI: 10.3109/02770903.2014.944982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess limited English proficiency (LEP) asthma caregiver quality of life (QoL), skills retention and healthcare utilization after an asthma education fair (AEF). METHODS A language concordant AEF was conducted at a Latino community center. LEP caregivers of children 1-12 years old and an established asthma diagnosis participated in three skill stations: (a) medication recognition and administration, (b) peak flow use (if child ≥ 5 years) and (c) action plan dissemination. Spacers, peak flow meters and individualized action plans were distributed. A validated, pediatric asthma caregiver quality of life questionnaire (PACQLQ-Spanish version) was administered. Baseline data was compared to follow-up interview data at three and six months after the AEF. Mean PACQLQ scores were analyzed with Wilcoxon signed-rank test and nominal paired data with McNemar's test. RESULTS We analyzed data from 18 caregivers able to speak English well (22%), not well (28%) or not at all (50%). After three months, improved caregiver QoL was experienced (51 vs. 72, p<0.01). No differences were observed in medication recognition, spacer and peak flow use or peak flow interpretation. After six months, mean school days missed due to asthma decreased (4.1 vs. 0.4, p<0.01). Mean clinic visits, emergency department visits and hospitalizations remained unchanged. CONCLUSIONS Implementation of a community-based AEF with action plan administration can be beneficial for LEP caregivers and their children. QoL improvements to emotional wellbeing and activity limitations were observed, and lower rates of school absenteeism were reported. Caregiver ability to accurately identify medications was not enhanced.
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Affiliation(s)
- Antonio Riera
- Pediatric Emergency Medicine, Yale University School of Medicine , New Haven, CT , USA
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Community-based interventions in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 795:105-15. [PMID: 24162905 DOI: 10.1007/978-1-4614-8603-9_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Community and public health interventions provide potentially powerful means of decreasing morbidity, hospitalizations, emergency room visits, and mortality from asthma. This chapter thus provides an overview of community-based interventions, which have been demonstrated to be effective-and/or ineffective-in reducing the burden of disease, including development of asthma coalitions, interventions for both provider and patient education, environmental controls to reduce exposure to asthma triggers, and institutional policy and systems change. Perhaps most important is the demonstrated effect of integrated, comprehensive approaches to asthma management and control. A multidisciplinary approach spanning T1 through T4 translational research, coupled with public health activities is promising and has already demonstrated success in reducing the burden of disease.
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Malcarney MB, Seiler N, Horton K. Using insurance laws to improve access to community-based asthma prevention. Public Health Rep 2013; 128:402-6. [PMID: 23997290 DOI: 10.1177/003335491312800512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mary-Beth Malcarney
- Mary-Beth Malcarney is an Assistant Research Professor, Naomi Seiler is an Associate Research Professor, and Katie Horton is a Research Professor, all in the Department of Health Policy at the George Washington University School of Public Health and Health Services in Washington, D.C
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[Impact of a small-group educational intervention for 4- to 12-year-old asthmatic children and their parents on the number of healthcare visits and quality of life]. Arch Pediatr 2013; 20:1201-1205. [PMID: 24119844 DOI: 10.1016/j.arcped.2013.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/17/2013] [Accepted: 08/26/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Asthma is the most frequent chronic disease in children. Many educational approaches to asthma exist, but there is no evidence of their effectiveness because of the heterogeneity of practices. Several studies show that good knowledge of the disease associated with personal skills and optimal medication improve treatment compliance and decrease school absenteism and asthma exacerbations. The "Asthma School" conducted in the Children's Hospital of Lausanne, Switzerland is in keeping with these recommendations. The aim of the study was to evaluate the impact of Asthma School (therapeutic education) on the number of medical visits in asthmatic children. We also assessed the quality of life of children and their caregivers. METHODS We included in a prospective longitudinal study every child aged 4 to 12 years and their parents attending Asthma School over 1 year and followed them at 6 months. The number of emergency visits, medical appointments, and hospitalizations during the year before and after Asthma School was assessed with a questionnaire administered to the family physicians (GPs, pediatricians). Quality of life was evaluated with the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) at inclusion and 6 months after. RESULTS Twenty-seven children and their parents were included. The mean age was 7.02 years. Pediatric visits, emergency visits, and hospitalizations decreased significantly between the year before and the year after Asthma School. Emergency visits were 41, 1 year before Asthma School and 21, 1 year after it, medical appointments were 62 vs 30, and hospitalizations were 17 vs 2, respectively. The Wilcoxon sign-rank test demonstrates a significant difference with P=0.010 for medical appointments, P=0.021 for emergency visits, and P=0.002 for hospitalizations. Quality of life in children improved in all domains but one evaluated by the PAQLQ(S) (score of 5.90 vs 6.52). Parental quality of life (PACQLQ) improved in all domains (overall score of 5.21 vs 6.15). CONCLUSION Interactive education on asthma improves clinically important outcomes and quality of life in children and their families. The skills acquired allow them to manage daily life.
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The impact of asthma health education for parents of children attending head start centers. J Community Health 2013; 37:1296-300. [PMID: 22648657 DOI: 10.1007/s10900-012-9571-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Parents of children who attend Head Start Centers are key participants in the health promotion and care of their own children. This non-randomized, longitudinal study aimed to test the effectiveness of an educational intervention based on the asthma and healthy homes curriculum targeting parents of Head Start children with or without an asthma diagnosis. One hundred and fifteen parents of children in Head Start Centers received an educational intervention at their corresponding sites, additionally pre- and post-test surveys were administered to measure educational intervention outcomes. A follow-up survey was conducted 6 months after the educational intervention was offered. Results showed a statistically significant increase in asthma and healthy home-knowledge (p < 0.001) in several areas. At 6 months post-intervention (54.4 %) (61 participants) were contacted and 98.4 % of made changes in their households as a result of their training. This study suggests that education can improve knowledge and change behaviors for the well-being of the residents of that household.
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Martinez J, Ro M, Villa NW, Powell W, Knickman JR. Transforming the delivery of care in the post-health reform era: what role will community health workers play? Am J Public Health 2011; 101:e1-5. [PMID: 22021289 PMCID: PMC3222444 DOI: 10.2105/ajph.2011.300335] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2011] [Indexed: 11/04/2022]
Abstract
The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs). Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed by CHWs for decades, particularly among underserved populations. The two key delivery models promoted in the PPACA are accountable care organizations and health homes. Both stress the importance of interdisciplinary, interprofessional health care teams, the ideal context for integrating CHWs. Equally important, the payment structures encouraged by PPACA to support these delivery models offer the vehicles to sustain the role of these valued workers.
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Meurer JR, Lyon-Callo S. Controlling Asthma in American Cities: major themes, persistent challenges, and next steps. J Urban Health 2011; 88 Suppl 1:30-7. [PMID: 21337049 PMCID: PMC3042059 DOI: 10.1007/s11524-010-9474-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- John R Meurer
- Department of Pediatrics, Medical College of Wisconsin, and Fight Asthma Milwaukee Allies, Children's Hospital and Health System, Milwaukee, WI, USA.
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Abstract
The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need.
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Affiliation(s)
- Elizabeth Jane Herman
- Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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