Asthma knowledge and management in primary schools in south Essex, UK

Current Asthma Management Practices by Primary School Teaching Staff: A Systematic Review

BACKGROUND

The likelihood of children with asthma experiencing an exacerbation at school is significantly high when considering that they spend a substantial part of their day at school. This study, therefore, aimed to systematically review the literature to determine current asthma management practices by primary school teaching staff and any existing supporting legislation/policies/guidelines.

METHODS

Search terms were adapted to search literature across databases: CINAHL, Cochrane Library, Education Database-ProQuest, IPA, MEDLINE, SCI. Primary research studies, reviews, systematic reviews, and meta-analyses in English about primary school teaching staff dated between 2007 and 2017 were included. Primary outcomes comprised teaching staff' practices regarding asthma management and supporting guidelines, policies, or legislation.

RESULTS

Analysis of the 13 papers eligible for full review identified that: teachers were unable to deal with an asthma exacerbation; they lacked knowledge regarding exercise-induced asthma and that there was poor communication between schools and parents of children with asthma. The only documented relevant asthma legislation found pertained to New York schools.

CONCLUSIONS

Limited evidence regarding asthma management practices and inadequate asthma management knowledge amongst teaching staff highlight the need for supporting teaching staff with asthma policies and guidelines to minimize risks associated with inappropriate asthma management.

Impact of scenario based training on asthma first aid knowledge and skills in school staff: an open label, three-arm, parallel-group repeated measures study

Objective: To test the hypothesis that scenario-based skills training is more effective than knowledge training alone in improving the asthma first aid skills of school personnel. Education developed specifically for non-primary caregivers such as school staff is vital to minimize the risk of mortality associated with asthma. Methods: Schools were allocated to one of three arms to compare AFA knowledge and AFA skills. Arm 1 underwent conventional asthma training, arm 2 underwent scenario-based training and arm 3 had a combination of the two. Conventional asthma training involved a didactic oral presentation. The scenario-based skills training required the participant to describe and demonstrate how they would manage a child having a severe exacerbation of asthma using equipment provided. Follow-up occurred at 3 weeks post baseline and again between 3-7 months after the first training/education visit. Results: Nineteen primary schools (204 participants) were recruited. One-way ANOVA and Bonferroni Post-Hoc Tests showed there was a significant difference in AFA skills scores between the study arms who underwent scenario-based training; arms 2 and 3 (91.5% and 91.1%) and arm 1 who underwent conventional asthma training (77.3%) (p < 0.001). AFA knowledge improved significantly in all study arms with no differences between study arms. Improvements seen in both AFA knowledge and AFA skills were maintained over time. Conclusions: Scenario-based training was superior to conventional didactic asthma training for AFA skills acquisition and overall competency in the administration of AFA and should be included in future asthma training programs.

Systematic review and content analysis of asthma knowledge questionnaires: A focus on the knowledge surrounding acute exacerbation management

OBJECTIVES

Asthma education is a key component of asthma management. Asthma education around the management of a person who is having an acute exacerbation of asthma (often referred to as asthma first aid (AFA) training) is important, particularly in a school setting. There is no gold standard assessment of asthma knowledge and also there is no specific tool to measure the knowledge of AFA. Our aim was to identify asthma knowledge questionnaires and perform a content analysis. We were interested in evaluating the number, the type and the format of AFA questions.

METHOD

A literature search was performed to identify the instruments which were able to assess asthma knowledge of people with asthma and/or caregivers of people with asthma. An electronic database search was performed in EMBASE, IPA, MEDLINE and PUBMED. Articles which described the development or psychometric testing of an asthma knowledge questionnaire were included. The content of questions in each instrument was analysed and categorised using the NVivo software, and a secondary analysis was performed to identify knowledge questions relevant to the management of an acute asthma exacerbation.

RESULTS

Forty-four papers with 37 different instruments met the inclusion criteria. The majority of the instruments contained a relatively low proportion of questions related to the management of acute asthma, i.e., only 162 of the 780 questions (21%). No questionnaire had sufficient specific emphasis on acute asthma management knowledge to test the impact of AFA training.

CONCLUSION

There is a scope to develop an up-to-date validated acute asthma management knowledge questionnaire for use in research and clinical settings.

Can schools promote the health of children with asthma?

This report describes the evaluation of a whole-school intervention to improve morbidity and psychosocial well-being in pupils with asthma. In all, 193 children with asthma (7-9 years) from 23 primary/junior schools in the south of England participated. Schools (n = 12) randomly assigned to the intervention group (IV) received a staff asthma training session, advice on asthma policy and practice and an emergency beta(2)-agonist inhaler with spacer. Pupils participated in an asthma lesson. Staff and pupils in non-intervention (NI) schools (n = 11) received no asthma-oriented input. While wheeze reports improved for all children with asthma, only the IV group showed lower requirement for medication (P = 0.01), clinically significant improvement (P < 0.05) in activity related quality of life (QOL) and increased self-esteem (SE: social P = 0.01; athletic P = 0.05; behaviour P = 0.001) in girls. SE decreased for NI girls but there was no change for non-asthmatic peers in NI or IV schools which had similar baseline levels of SE and QOL. There was a marginal improvement in the establishment of asthma policies/practices and no change in school absence or staff knowledge. The significantly increased peer group understanding of asthma seen in the intervention schools may have mediated increased well-being in the IV group. Primary schools are a potentially important context for improving asthma morbidity and psychosocial well-being of children with asthma.