Multimodal patient education program with stress management for childhood and adolescent asthma

Development and effects of salutogenesis program for adolescents with moyamoya disease: A randomized controlled trial

BACKGROUND

Disease-specific interventions for management and health behavior implementation are needed to improve the health and quality of life of adolescents with moyamoya disease.

OBJECTIVE

This study aimed to develop a program for adolescents with moyamoya disease based on the salutogenesis theory, which focuses on the process of enhancing health through successful adaptation to external stressors, and to evaluate its effectiveness.

METHODS

A randomized controlled trial was performed according to the CONSORT guidelines. This preliminary research and experimental treatment were conducted at a Severance Hospital ward and outpatient clinic among 48 participants randomized into the intervention (seven sessions of salutogenesis program, n = 24) or the control group (one session of one-to-one moyamoya disease education program, n = 24) from September 6, 2018 to January 4, 2019. Changes in the following study outcomes were reported: "knowledge of moyamoya disease," "social support," "sense of coherence," "moyamoya disease health behavior," "stress," "depression," "subjective health status," "frequency of ischemic symptoms," and "quality of life".

RESULTS

The salutogenesis program improved the knowledge and social support of adolescents with illness-related problems and helped them attain healthy behaviors and stress reduction. It was confirmed to be effective in improving their quality of life.

CONCLUSIONS

The salutogenesis program for adolescents with moyamoya disease effectively improved the generalized resistance resources and sense of coherence in adolescents with moyamoya disease.

TRIAL REGISTRATION

Korean Clinical Research Information Service registry, KCT0006869.

Applying theoretical models of positive emotion to improve pediatric asthma: A positive psychology approach

Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma.

Insights in Public Health: Ask the Keiki: Perceived Factors that Affect Asthma Among Adolescents from the Wai'anae Coast Using Photovoice

Hawai'i has among the highest childhood asthma prevalence compared to all other states in the United States. Native Hawaiian children have a higher prevalence of asthma compared other racial/ethnic groups in the state. Photovoice is a method in community-based participatory research that enables participants to use photos to express themselves and advocate on behalf of their community. In this study, students from the Wai'anae Coast used Photovoice to identify perceived factors that affect asthma management. Seven students, ages 14 and 18, with self-reported asthma met virtually, with facilitators, after school once a week for four weeks. Students identified eight factors as positively or negatively impacting the students' asthma and explained how these factors influence their health. The Photovoice results provided an in-depth understanding on the role a student's culture and environment plays in asthma management. Continued efforts to develop asthma education programs tailored to address the specific factors that youth identify as impacting their asthma may be more effective in reducing asthma disparities. Future research should expand on the key themes identified in this study and include continued advocacy efforts among students to improve asthma-related outcomes in this community.

Online, Group-Based Psychological Support for Adolescent and Young Adult Cancer Survivors: Results from the Recapture Life Randomized Trial

Telehealth interventions offer a practical platform to support adolescent and young adult (AYA) cancer survivors' mental health needs after treatment, yet efficacy data are lacking. We evaluated an online, group-based, videoconferencing-delivered cognitive-behavioral therapy (CBT) intervention ('Recapture Life') in a 3-arm randomized-controlled trial comparing Recapture Life with an online peer-support group, and a waitlist control, with the aim of testing its impact on quality of life, emotional distress and healthcare service use. Forty AYAs (Mage = 20.6 years) within 24-months of completing treatment participated, together with 18 support persons. No groupwise impacts were measured immediately after the six-week intervention. However, Recapture Life participants reported using more CBT skills at the six-week follow-up (OR = 5.58, 95% CI = 2.00-15.56, p = 0.001) than peer-support controls. Recapture Life participants reported higher perceived negative impact of cancer, anxiety and depression at 12-month follow-up, compared to peer-support controls. Post-hoc analyses suggested that AYAs who were further from completing cancer treatment responded better to Recapture Life than those who had completed treatment more recently. While online telehealth interventions hold promise, recruitment to this trial was challenging. As the psychological challenges of cancer survivorship are likely to evolve with time, different support models may prove more or less helpful for different sub-groups of AYA survivors at different times.

Skin and Psychosomatics - Psychodermatology today

Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.

The effectiveness of interventions to improve self-management for adolescents and young adults with allergic conditions: A systematic review

BACKGROUND

This systematic review aimed to review the literature on interventions for improving self-management and well-being in adolescents and young adults (11-25 years) with asthma and allergic conditions.

METHODS

A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative synthesis was undertaken.

RESULTS

A total of 30 papers reporting data from 27 studies were included. Interventions types were psychological (k = 9); e-health (k = 8); educational (k = 4); peer-led (k = 5); breathing re-training (k = 1). All interventions were for asthma. Psychological interventions resulted in significant improvements in the intervention group compared with the control group for self-esteem, quality of life, self-efficacy, coping strategies, mood and asthma symptoms. E-Health interventions reported significant improvements for inhaler technique, adherence and quality of life. General educational interventions demonstrated significantly improved quality of life, management of asthma symptoms, controller medication use, increased use of a written management plan and reduction in symptoms. The peer-led interventions included the Triple A (Adolescent Asthma Action) programme and a peer-led camp based on the Power Breathing Programme. Improvements were found for self-efficacy, school absenteeism and quality of life.

CONCLUSION

Although significant improvements were seen for all intervention types, many were small feasibility or pilot studies, few studies reported effect sizes and no studies for allergic conditions other than asthma met the inclusion criteria. Research using large longitudinal interventional designs across the range of allergic conditions is required to strengthen the evidence base.

A randomized pilot trial of a school-based psychoeducational intervention for children with asthma

BACKGROUND

Asthma is a common childhood illness with high morbidity and mortality among minority and socio-economically disadvantaged children. Disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. One such factor is psychological stress.

OBJECTIVE

Here, we examine the feasibility and acceptability of "I Can Cope (ICC)," a school-based stress management and coping intervention for children with asthma.

METHODS

A parallel randomized pilot trial was conducted. One hundred and four low-income children (mean age 10 years; 54% male; 70% African American) with persistent asthma were recruited from 12 urban schools and randomized to the following: (a) ICC or one of two control conditions: (b) "Open Airways for Schools (OAS)"-an asthma education intervention or (c) no treatment.

RESULTS

Seventy one percentage of eligible children participated in the study, with a dropout rate of 12%. ICC was rated as highly acceptable by participating children and parents. Preliminary efficacy data suggest that when compared with no treatment, ICC resulted in decreased symptoms of depression, perceived stress and child-reported symptoms of asthma, and improvements in sleep quality and child-reported asthma control. There were no intervention-related changes in objective measures of asthma morbidity. The magnitude of intervention effects on psychological function did not differ between the ICC and OAS groups.

CONCLUSIONS

Results support the feasibility and acceptability of utilizing school-based interventions to access hard to reach children with asthma. Preliminary findings offer support for future, large-scale efficacy studies of school-based interventions designed to target multiple factors that contribute to asthma disparities.

Stressors of School-age Children With Allergic Diseases: A Qualitative Study

PURPOSE

Most studies of stress in children with chronic diseases have been geared toward parents and caregivers have not considered allergic diseases together. This study aimed to identify the stressors associated with allergic diseases in Japanese school-age children.

DESIGN AND METHODS

Stressors associated with allergic diseases of 11 school-age children (seven boys and four girls; age range: 9-12 years) were investigated using semi-structured interviews.

RESULTS

In the qualitative thematic analysis of stressors about allergic diseases, two themes: allergic disease-specific stressors and common stressors in chronic diseases, and 12 categories were identified. A thematic map was applied to four domains of stressor: physiological factors, psychological factors, social factors, and environmental factors.

CONCLUSIONS

The results showed that school-age children with allergic diseases have a variety of stressors. Future studies should aim to develop an allergic disease-specific stress management program with school-age children.

PRACTICE IMPLICATIONS

In children with allergic diseases, not only is stress management in daily life important, but also stress management for disease-specific matters to control the symptoms and maintain mental health. Stress management should be supported for school-age children with allergic diseases.

Cognitive behavioural therapy (CBT) for adults and adolescents with asthma

BACKGROUND

People with asthma have a higher prevalence of anxiety and depression than the general population. This is associated with poorer asthma control, medication adherence, and health outcomes. Cognitive behavioural therapy (CBT) may be a way to improve the quality of life of people with asthma by addressing associated psychological issues, which may lead to a lower risk of exacerbations and better asthma control.

OBJECTIVES

To assess the efficacy of CBT for asthma compared with usual care.

SEARCH METHODS

We searched the Cochrane Airways Group Specialised Register, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also searched reference lists of all primary studies and review articles and contacted authors for unpublished data. The most recent searches were conducted in August 2016.

SELECTION CRITERIA

We included parallel randomised controlled trials (RCTs) comparing any cognitive behavioural intervention to usual care or no intervention. We included studies of adults or adolescents with asthma, with or without comorbid anxiety or depression. We included studies reported as full text, those published as abstract only, and unpublished data.

DATA COLLECTION AND ANALYSIS

Two or more review authors independently screened the search results, extracted data, and assessed included studies for risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMD) where scales varied across studies, all using a random-effects model. The primary outcomes were asthma-related quality of life and exacerbations requiring at least a course of oral steroids. We rated all outcomes using GRADE and presented our confidence in the results in a 'Summary of findings' table.

MAIN RESULTS

We included nine RCTs involving 407 adults with asthma in this review; no studies included adolescents under 18. Study size ranged from 10 to 94 (median 40), and mean age ranged from 39 to 53. Study populations generally had persistent asthma, but severity and diagnostic measures varied. Three studies recruited participants with psychological symptomatology, although with different criteria. Interventions ranged from 4 to 15 sessions, and primary measurements were taken at a mean of 3 months (range 1.2 to 12 months).Participants given CBT had improved scores on the Asthma Quality of Life Questionnaire (AQLQ) (MD 0.55, 95% confidence interval (CI) 0.17 to 0.93; participants = 214; studies = 6; I2 = 53%) and on measures of asthma control (SMD -0.98, 95% CI -1.76 to -0.20; participants = 95; studies = 3; I2 = 68%) compared to people getting usual care. The AQLQ effect appeared to be sustained up to a year after treatment, but due to its low quality this evidence must be interpreted with caution. As asthma exacerbations requiring at least a course of oral steroids were not consistently reported, we could not perform a meta-analysis.Anxiety scores were difficult to pool but showed a benefit of CBT compared with usual care (SMD -0.38, 95% CI -0.73 to -0.03), although this depended on the analysis used. The confidence intervals for the effect on depression scales included no difference between CBT and usual care when measured as change from baseline (SMD -0.33, 95% CI -0.70 to 0.05) or endpoint scores (SMD -0.41, 95% CI -0.87 to 0.05); the same was true for medication adherence (MD -1.40, 95% CI -2.94 to 0.14; participants = 23; studies = 1; I2 = 0%).Subgroup analyses conducted on the AQLQ outcome did not suggest a clear difference between individual and group CBT, baseline psychological status, or CBT model. The small number of studies and the variation between their designs, populations, and other intervention characteristics limited the conclusions that could be drawn about these possibly moderating factors.The inability to blind participants and investigators to group allocation introduced significant potential bias, and overall we had low confidence in the evidence.

AUTHORS' CONCLUSIONS

For adults with persistent asthma, CBT may improve quality of life, asthma control, and anxiety levels compared with usual care. Risks of bias, imprecision of effects, and inconsistency between results reduced our confidence in the results to low, and evidence was lacking regarding the effect of CBT on asthma exacerbations, unscheduled contacts, depression, and medication adherence. There was much variation between studies in how CBT was delivered and what constituted usual care, meaning the most optimal method of CBT delivery, format, and target population requires further investigation. There is currently no evidence for the use of CBT in adolescents with asthma.

Self-management interventions for young people with chronic conditions: A systematic overview

OBJECTIVE

To provide a systematic overview of self-management interventions (SMI) for young people with chronic conditions with respect to content, formats, theories, and evaluated outcomes.

METHODS

Embase, Medline, PsycINFO, Web-of-Science, CINAHL, and Cochrane were searched. Reviews' reference lists were scrutinized. Selected studies were: Original research articles in English published between 2003 and March 2014; about the evaluation of SMI for 7 to 25-year-olds with somatic chronic conditions/physical disabilities; with clear outcomes and intervention descriptions. The classification of medical, role and emotion management served to review content. Formats, theories, and evaluated outcomes were summarized.

RESULTS

86 studies were reviewed. Most aimed at medical management and were unclear about theoretical bases. Although a variety of outcomes was evaluated and the distribution over self-management domains was quite unpredictable, outcomes conceptually related to specific content. A content-based framework for the evaluation of self-management interventions is presented.

CONCLUSIONS AND PRACTICE IMPLICATIONS

SMI relate to self-management tasks and skill-building. Yet, conceptualizations of self-management support often remained unclear and content focuses predominantly on the medical domain, neglecting psycho-social challenges for chronically ill young people. Future evaluations should match outcomes/themes to content and characteristics. Our framework and overview of SMI characteristics and outcomes may assist clinicians in providing self-management support.

Reconciling preferences and constraints in online peer support for youth with asthma and allergies

In this article, we examine the opportunities and constraints of professionally mediated social networking in health promotion practice. Our analysis is based on the findings of a 12-week participatory study of a peer-led support intervention for youth with asthma and life-threatening allergies. The article begins with an overview of the preferences of youth, their parents, and young adults recruited as peer mentors for online features in the design of a customized support program. We then briefly explain the rationale behind our decision to design and host our intervention using a publicly available website called Ability Online in an effort to balance participants' preferences with important research obligations and safety requirements. Finally, we report on participants' level of satisfaction with the intervention as well as recommendations for health practitioners who wish to use social networking to enhance supports for youth with chronic health conditions.

Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: a multicenter randomised controlled trial of Recapture Life-AYA

BACKGROUND

A cancer diagnosis is 2.9 times more likely to occur during the adolescent and young adult years than in younger children. This spike in incidence coincides with a life stage characterised by psychological vulnerability as young people strive to attain numerous, critical developmental milestones. The distress young people experience after cancer treatment seriously jeopardises their ability to move into well-functioning adulthood.

METHODS/DESIGN

This article presents the protocol of the Recapture Life study, a phase II three-arm randomised controlled trial designed to evaluate the feasibility and efficacy of a new intervention in reducing distress and improving quality of life for adolescent and young adult cancer survivors. The novel intervention, "ReCaPTure LiFe" will be compared to a both a wait-list, and a peer-support group control. Ninety young people aged 15-25 years who have completed cancer treatment in the past 1-6 months will be recruited from hospitals around Australia. Those randomised to receive Recapture Life will participate in six, weekly, 90-minute online group sessions led by a psychologist, involving peer-discussion around cognitive-behavioural coping skills (including: behavioural activation, thought challenging, communication and assertiveness skills training, problem-solving and goal-setting). Participants randomised to the peer-support group control will receive non-directive peer support delivered in an identical manner. Participants will complete psychosocial measures at baseline, post-intervention, and 12-months post-intervention. The primary outcome will be quality of life. Secondary outcomes will include depression, anxiety, stress, family functioning, coping, and cancer-related identity.

DISCUSSION

This article reviews the empirical rationale for using group-based, online cognitive-behavioural therapy in young people after cancer treatment. The potential challenges of delivering skills-based programs in an online modality are highlighted, and the role of both peer and caregiver support in enhancing the effectiveness of this skills-based intervention is also discussed. The innovative videoconferencing delivery method Recapture Life uses has the potential to address the geographic and psychological isolation of adolescents and young adults as they move toward cancer survivorship. It is expected that teaching AYAs coping skills as they resume their normal lives after cancer may have long-term implications for their quality of life.

TRIAL REGISTRATION

ACTRN12610000717055.

Impact of online support for youth with asthma and allergies: pilot study

Youth with asthma and allergies often feel isolated and different from their peers. The objective of this study was to test the impact of online social support for these youth. Three months of support was provided using weekly synchronous chat sessions. Online sessions were facilitated by trained peer mentors (older youth with asthma and/or allergies) and health professionals. Youth could also e-mail one another between chat sessions and post messages on an electronic community bulletin board. Twenty-eight adolescents across Canada participated. Social isolation and loneliness were significantly reduced. Youth reported gaining confidence and a sense of normality.

Preliminary evidence for the feasibility of a stress management intervention for 7- to 12-year-olds with asthma

OBJECTIVE

Evidence supports a bidirectional relationship between stress and asthma exacerbations in children, suggesting that interventions to reduce stress may improve both psychosocial quality of life and disease course. Here, we examine the feasibility of a stress management intervention for 7- to 12-year-olds with asthma.

METHODS

Two trials were conducted. Cohort 1 (n = 11) was recruited from the community and attended intervention sessions at an urban university. Cohort 2 (n = 7) was school based and recruited from an African American charter school. Six individual intervention sessions focused on psychoeducation about asthma, stress, and emotions; problem-solving and coping skills training; and relaxation training paired with physiological feedback. Pre- and post-intervention stress, mood, and lung function data were collected. Satisfaction surveys were administered after intervention completion.

RESULTS

The intervention was rated as highly acceptable by participating families. Feasibility was much stronger for the school-based than the university-based recruitment mechanism. Initial efficacy data suggest that both cohorts showed pre- to post-intervention improvements in lung function, perceived stress, and depressed mood.

CONCLUSION

Findings provide evidence for the feasibility of offering asthma-related stress management training in a school setting. Initial findings offer support for future, large-scale efficacy studies.

Online Support Intervention for Adolescents With Asthma and Allergies

Objectives. To determine appropriate components and contents of an online peer support intervention for young adolescents and to evaluate intervention processes, perceived benefits, and satisfaction with the intervention.

Methods. Three months of support were provided through synchronous chat, e-mail exchange, instant messaging, and bulletin boards. Online support group sessions were facilitated by trained peer mentors (older youth/young adults with asthma and allergies) and health professionals. Participant use of online options was tracked (eg, log-ons, e-mails, chat minutes). Qualitative data were elicited from peer mentor reports, online support group chat transcripts, project coordinators’ field notes, peer mentor exit interviews, and adolescent telephone interviews.

Results. Almost all adolescents were satisfied with this online support intervention. Topics discussed in the support groups were pertinent to their educational and support needs. Peer mentors provided emotional, affirmation, and information support. Participants appreciated opportunities for social comparison and reciprocal exchange of support with peers.

Conclusion and implications. A major contribution was documentation of the complex intervention ingredients and processes through qualitative and quantitative methods that elicited diverse stakeholders’ perspectives. This strategy enables adaptation and integration into practice. Adolescents who benefited most felt isolated, suggesting the importance of targeting vulnerable youth for support programs.

[Gender-specific stress management training at school]

Gender differences in coping suggest the conceptualization of gender-specific stress management trainings for adolescents. In this pilot study, the acceptance of the newly developed school-based cognitive-behavioral stress management training was examined and preliminary results of the effectiveness of our gender-specific program were obtained. The intervention effects on coping were investigated in N=35 girls and N=45 boys of the fifth and sixth grade using a within design, separately analysed for both genders and consisting of three four weeks intervals: The no-treatment period before the intervention served as control period. The stress management training with six sessions within the school setting were delivered in the following experimental period. During the follow-up period the mid term intervention effects were examined. Girls benefited in minimization and relaxation in the short term. Boys improved in relaxation coping in the short and mid term. Boys also decreased in externalizing coping in the short run. Results are discussed with regard to modifications of the gender-specific program.

Cognitive-behavioral stress management training for boys with functional urinary incontinence

OBJECTIVE

To evaluate an inpatient education program involving cognitive-behavioral stress management training of boys (aged 8-12 years) with functional urinary incontinence.

METHODS

The short- and long-term intervention effects of the new program on incontinence frequency, quality of life, and coping with daily and illness-related stressors were investigated in 15 boys, compared to 10 boys on a more knowledge-oriented education program without stress management. The efficacy was evaluated by non-parametric methods.

RESULTS

In both groups daytime wetting decreased while adaptive coping with daily stressors increased. Only the boys in the experimental group improved their wetting frequency during the night, maladaptive coping with illness-related stressors, and self-esteem.

CONCLUSIONS

Stress management training should be incorporated in patient education programs to enhance coping of children with illness-related stressors and low self-esteem.

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries

OBJECTIVE

To evaluate a newly developed education programme for Parkinson's disease (PD) patients.

METHODS

The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression.

RESULTS

The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures.

CONCLUSION

Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD.

PRACTICE IMPLICATIONS

The present programme will soon be available in seven European languages and can be tested in different health care systems.

Health promotion needs of children and adolescents in hospitals: a review

The concept of health promotion for children and adolescents in hospitals is relatively new, and an international working group within the WHO-network of Health Promoting Hospitals, is currently seeking to establish specific guidelines. An exploratory study based on a literature review was performed in order to identify (i) what are the health promotion needs of children and adolescents when they access the hospital either as patients, as visitors, or as members of their community; and (ii) if there are any recommended strategies to empower children and strengthen their life-skills and participation capacity in the hospital, as recommended by the Ottawa Charter for Health Promotion. The results of this literature review are mainly descriptive of current practices and recommendations regarding organizational issues, health-care providers' practice behavior, health-care providers' skills and training, children's education, education of parents and social environment.

Advances in development and evaluation of asthma education programs

PURPOSE OF REVIEW

Effective asthma education requires more than merely providing information on asthma. Behavior change and learning principles must be incorporated into educational programs. However, there remains much debate and research about the most effective strategies to educate people to deal effectively with their asthma. This article focuses on recent advances in theoretical and practical strategies and examines core elements of successful asthma education programs.

RECENT FINDINGS

Asthma education has improved in recent years as a result of application of evidence-based, theoretical principles that guide learning and behavior modification. Many studies show a refreshing focus on how to teach and have made substantial contributions to testing educational theories and making meaningful improvements to those with asthma. Successful asthma education programs include behavior change strategies, shared care practices and communication skills, a clear educational process, tailoring to client needs and influencing factors, multiple teaching formats, and a continuum of care.

SUMMARY

An array of effective and innovative asthma education programs have been developed and tested. However, numerous areas in asthma education require improvement and further research, such as real-world models, sensitivities to underserved populations or venues, innovative partnerships, continuum of care, and patient incentive/participation.