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Amorha KC, Ochie KM, Ogbodo SC, Akunne OZ, Obi OC, Ene NT, Ifeanyi CR, Ikokwu J, Eze CV, Ogbonna ET, Chukwu MI, Okafor CC, Echeta CR, Nwani SP, Okoye CO, Okonkwo VC, Eneje CJ, Ozota GO. Are boarding secondary schools suitable for students with asthma? An asynchronous online focus group discussion among members of an asthma awareness group. PLoS One 2024; 19:e0304123. [PMID: 39241018 DOI: 10.1371/journal.pone.0304123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/07/2024] [Indexed: 09/08/2024] Open
Abstract
INTRODUCTION Children in boarding schools spend most of their time without their parents or caregivers, causing concerns about the suitability of such schools for children with asthma. This study assessed individuals' opinions regarding the suitability of boarding secondary schools for children with asthma. METHODS A qualitative design was adopted for this study using a focus group discussion held on a social media platform (WhatsApp®) of the Asthma Awareness and Care Group (AACG), The group comprised 150 registered members. The study was guided by a structured protocol and based on a vignette comprising three questions. Data were analysed via thematic analysis using framework principles. RESULTS Out of the 150 eligible members, there were responses from only 19 participants. Majority of the respondents were aged ≤ 30 years (n = 17, 89.5%). The three main themes generated from the thematic analysis include the appropriateness of boarding schools for children with asthma; facilities necessary for boarding schools to cater to children with asthma; and outright rejection of children with asthma by boarding schools. Respondents conceptualised the appropriateness of boarding schools for students with asthma in six distinct sub-themes: asthma severity and extent of control, child's self-efficacy and assertiveness, child equipped with tools (knowledge, inhalers, and asthma control diary), school awareness, facilities, and active support, availability of a guardian, and the knowledge and perception of teachers and schoolmates about asthma. The sub-themes associated with the themes were presented, alongside exemplar quotes from respondents. The majority of the respondents (61.5%) were in support of allowing children with asthma attend boarding schools but with some caveats such as without liability to the school, if facilities are unavailable. CONCLUSION Children's age, autonomy, asthma management status, and the school's readiness were identified as important considerations for the safe attendance of children with asthma at boarding schools.
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Affiliation(s)
- Kosisochi Chinwendu Amorha
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Bingham University, Karu, Nasarawa State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Kossy Maryann Ochie
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Stephen Chukwuma Ogbodo
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Pharmacy Department, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Olisaemeka Zikora Akunne
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- ASK Medical and Diagnostic Center, Federal Capital Territory, Abuja, Nigeria
| | - Ogechi Christiana Obi
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Nwamaka Theresa Ene
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Kareda Pharmacy, Asaba, Delta State, Nigeria
| | - Chukwudi Richard Ifeanyi
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- National Institute for Pharmaceutical Research and Development, Abuja, Nigeria
| | - Jonathan Ikokwu
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Pharmacy Council of Nigeria, Lagos Zonal Office, Yaba, Lagos State, Nigeria
| | - Chibuike Victor Eze
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Emmanuella Tochukwu Ogbonna
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Marydith Ifeoma Chukwu
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Federal Medical Center, Lokoja, Kogi State, Nigeria
| | - Chinedu Collins Okafor
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Lyn Edge Pharmaceuticals Limited, Lagos, Nigeria
| | - Chiamaka Ruth Echeta
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Somtochi Prosper Nwani
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
- Medplus Pharmacy Nigeria Limited, Lagos, Nigeria
| | - Christabel Ogechukwu Okoye
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Vanessa Chinweike Okonkwo
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Chisom Jennifer Eneje
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
| | - Gerald Obinna Ozota
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu, Enugu State, Nigeria
- Asthma Awareness and Care Group (AACG), Nsukka, Enugu State, Nigeria
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Uchima O, Keaulana S, Okihiro M, Sentell T. A scoping review of school-based asthma education programs for reducing children’s need for acute care services. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Olivia Uchima
- Graduate of the PhD in Public Health, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - Samantha Keaulana
- Doctoral Candidate of the Office of Public Health Studies, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - May Okihiro
- Pediatrician in the Department of Pediatrics, The University of Hawaii at Manoa, Honolulu, HI, USA
| | - Tetine Sentell
- Director and Professor of the Office of Public Health Studies, the University of Hawaii at Manoa, Honolulu, HI, USA
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Camp-Spivey LJ, Logan A, Nichols M. Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review. J Child Health Care 2022; 26:242-261. [PMID: 33913767 DOI: 10.1177/13674935211013697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl's methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.
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Affiliation(s)
- Logan J Camp-Spivey
- College of Nursing, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Ayaba Logan
- Libraries Department of Research & Education Services, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, 2345Medical University of South Carolina, Charleston, SC, USA
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Halterman JS, Riekert KA, Fagnano M, Tremblay P, Blaakman S, Tajon R, Wang H, Borrelli B. Effect of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity: a 3-arm randomized controlled trial. J Asthma 2022; 59:494-506. [PMID: 33307900 PMCID: PMC8285039 DOI: 10.1080/02770903.2020.1856869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Urban adolescents with asthma often have inadequate preventive care. We tested the effectiveness of the School-Based Asthma Care for Teens (SB-ACT) program on asthma morbidity and preventive medication adherence.Methods:Subjects/Setting- 12-16yr olds with persistent asthma in Rochester, NY schools. Design- 3-group randomized trial (2014-2019). SB-ACT Intervention- Two core components: 1) Directly observed therapy (DOT) of preventive asthma medications, provided in school for at least 6-8 weeks for the teen to learn proper technique and experience the benefits of daily preventive therapy; 2) 4-6 weeks later, 3 sessions of motivational interviewing (MI) to discuss potential benefits from DOT and enhance motivation to take medication independently. We included 2 comparison groups: 1) DOT-only for 6-8wks, and 2) asthma education (AE) attention control. Masked follow-up assessments were conducted at 3, 5, and 7mos. Outcomes- Mean number of symptom-free days (SFDs)/2 weeks and medication adherence. Analyses- Modified intention-to-treat repeated measures analysis.Results: We enrolled 430 teens (56% Black, 32% Hispanic, 85% Medicaid). There were no group differences at baseline. We found no difference in SFDs at any follow-up timepoint. More teens in the SB-ACT and DOT-only groups reported having a preventive asthma medication at each follow-up (p<.001), and almost daily adherence at 3 and 5-months (p<.001, p=.003) compared to AE. By 7 months there were no significant differences between groups in adherence (p=.49).Conclusion: SB-ACT improved preventive medication availability and short-term adherence but did not impact asthma symptoms. Further work is needed to create developmentally appropriate and effective interventions for this group.
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Affiliation(s)
- Jill S. Halterman
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University
| | - Maria Fagnano
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center
| | - Paul Tremblay
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center
| | | | - Reynaldo Tajon
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center
| | - Honguye Wang
- Department of Biostatistics, School of Medicine and Dentistry, University of Rochester
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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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Amorha KC, Asogwa EQ, Ibenekwu CS, Ogbonna ET, Amorha AO. Knowledge and perception about asthma among students in a Nigerian single-sex secondary school. CLINICAL RESPIRATORY JOURNAL 2021; 15:1121-1129. [PMID: 34224648 DOI: 10.1111/crj.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Asthma is prevalent among children and adolescents. Few studies have assessed the knowledge and perceptions of asthma among adolescents. OBJECTIVES This study assessed the knowledge and perception about asthma among secondary school students in an all-girls school in Nigeria. METHODS This cross-sectional study was conducted in a Nigerian secondary school in Enugu State (February 2020). In Senior Secondary School (SS1, SS2 and SS3), students could be in one of three specialized classes: Sciences, Humanities and Business. A self-administered structured questionnaire was filled by conveniently sampled students in SS1 and SS2. Inferential statistics utilized the Pearson's chi-square test and multiple linear regression with statistical significance set as P < 0.05. RESULTS Three hundred and eighty-eight (388) students participated in the study (mean age = 14.64 ± 0.93 years). Majority of the students were in Science class (n = 299; 77.1%). There was high awareness about asthma (n = 384; 99.0%). More than half of them had good asthma knowledge (n = 279; 71.9%); close to three-fifths had favourable perception of asthma (n = 222; 57.2%). More students in SS2 had good knowledge of asthma compared to those in SS1 (76.7% vs. 67.2%; ꭓ2 = 4.338; P = 0.037). More students in Science class had favourable perceptions about asthma compared with those in Humanities and Business class (60.5% vs. 48.1% vs. 25.0%; ꭓ2 = 7.458; P = 0.024). CONCLUSION Majority of the students were aware about asthma and had good knowledge of the disease while close to three-fifths had favourable perceptions about asthma.
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Affiliation(s)
- Kosisochi Chinwendu Amorha
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria.,Asthma Awareness and Care Group, Nigeria
| | - Ezinne Queendalyn Asogwa
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria.,Asthma Awareness and Care Group, Nigeria
| | - Chisom Sandra Ibenekwu
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria.,Asthma Awareness and Care Group, Nigeria
| | - Emmanuella Tochukwu Ogbonna
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu State, Nigeria.,Asthma Awareness and Care Group, Nigeria
| | - Adanne Onyedikachi Amorha
- Asthma Awareness and Care Group, Nigeria.,Pharmacy Department, Mater Misericordiae Hospital, Afikpo North, Ebonyi State, Nigeria
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Ramdzan SN, Suhaimi J, Harris KM, Khoo EM, Liew SM, Cunningham S, Pinnock H. School-based self-management interventions for asthma among primary school children: a systematic review. NPJ Prim Care Respir Med 2021; 31:18. [PMID: 33795691 PMCID: PMC8016947 DOI: 10.1038/s41533-021-00230-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/26/2021] [Indexed: 11/09/2022] Open
Abstract
A Cochrane review of school-based asthma interventions (combining all ages) found improved health outcomes. Self-management skills, however, vary according to age. We assessed effectiveness of primary school-based self-management interventions and identified components associated with successful programmes in children aged 6-12 years. We updated the Cochrane search (March 2020) and included the Global Health database. Two reviewers screened, assessed risk-of-bias and extracted data. We included 23 studies (10,682 participants); four at low risk-of-bias. Twelve studies reported at least one positive result for an outcome of interest. All 12 positive studies reported parental involvement in the intervention, compared to two-thirds of ineffective studies. In 10 of the 12 positive studies, parental involvement was substantial (e.g. attending sessions; phone/video communication) rather than being provided with written information. School-based self-management intervention can improve health outcomes and substantial parental involvement in school-based programmes seemed important for positive outcomes among primary school children.
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Affiliation(s)
- Siti Nurkamilla Ramdzan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Suhaimi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Katherine M Harris
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Steve Cunningham
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
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Mosler G, Harris K, Grigg J, Steed L. Developing a theory-based multimedia intervention for schools to improve young people's asthma: my asthma in school (MAIS). Pilot Feasibility Stud 2020; 6:122. [PMID: 32884832 PMCID: PMC7465390 DOI: 10.1186/s40814-020-00670-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 08/19/2020] [Indexed: 01/30/2023] Open
Abstract
Background Asthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents. Methods The intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13. Results The complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma. Conclusion This study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.
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Affiliation(s)
- Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Katherine Harris
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, 58 Turner St, London, E1 2AB UK
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Schneider T. Asthma and Academic Performance Among Children and Youth in North America: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2020; 90:319-342. [PMID: 31998975 DOI: 10.1111/josh.12877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The increasing prevalence of asthma among adolescents and the limited studies exploring the educational outcomes for youth coping with asthma makes the inquiry in this field of special interest. This paper reviews the literature on empirical studies exploring the relationship between asthma and academic performance among adolescents. METHODS Five databases (CINAHL, PubMed, ERIC EBSCO, Web of Science, and PsycINFO) were searched for peer-reviewed empirical studies exploring the link between asthma and academic performance utilized. Studies were reviewed, logged, and assessed studies for their research design, methods, and findings. Data synthesis incorporated strengths, limitations, and recommendations for future research and practice. RESULTS Twenty studies met the inclusion criteria. Of these, 13 employed a survey design and 7 evaluated school-based interventions implementing an experimental design. Whereas researchers applied quantitative methods in all the studies, qualitative and mixed-method designs were infrequently used. Studies showed a link between school absenteeism and asthma; other academic indicators (eg, graduation and test-scores) showed inconsistent correlation. CONCLUSIONS Future research should deploy more variable research designs and methods to improve understanding of the factors contributing to the relationship between adolescent asthma and academic performance. Additional topic-specific inquiry is needed to inform school practices and policies.
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Affiliation(s)
- Tali Schneider
- Deputy Director, , Florida Prevention Research Center, University of South Florida, Tampa, FL, 33613
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Kakumanu S, Lemanske RF. Asthma in Schools: How School-Based Partnerships Improve Pediatric Asthma Care. Immunol Allergy Clin North Am 2019; 39:271-281. [PMID: 30954176 DOI: 10.1016/j.iac.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-supported framework to coordinate care with schools.
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Affiliation(s)
- Sujani Kakumanu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Veterans Memorial Hospital, 600 Highland Avenue CSC 9988, Madison, WI 53792, USA.
| | - Robert F Lemanske
- Department of Pediatrics, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA; Department of Medicine, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA
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Stenberg U, Haaland-Øverby M, Koricho AT, Trollvik A, Kristoffersen LGR, Dybvig S, Vågan A. How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions. Health Expect 2019; 22:849-862. [PMID: 31131527 PMCID: PMC6803408 DOI: 10.1111/hex.12906] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This scoping review aims to give a comprehensive and systematic overview of published evaluations and the potential impact of patient education interventions for children, adolescents and young adults who are living with chronic illness and/or impairment loss. Methods Relevant literature published between 2008 and 2018 has been comprehensively reviewed, with attention paid to variations in study, intervention and patient characteristics. Arksey and O'Malley's framework for scoping studies guided the review process, and thematic analysis was undertaken to synthesize extracted data. Results Of the 7214 titles identified, 69 studies were included in this scoping review. Participant‐reported benefits of the interventions included less distress from symptoms, improved medical adherence and/or less use of medication, and improved knowledge. The majority of studies measuring physical activity and/or physiologic outcomes found beneficial effects. Interventions were also beneficial in terms of decreased use of urgent health care, hospitalization, visits to general practitioner and absence from school. By sharing experiences, participants had learned from each other and attained new insight on how they could manage illness‐related challenges. Discussion Study results corroborate previous research suggesting that different types of patient education interventions have a positive impact on children, adolescents and young adults, but research on this field is still in a starting phase. The results summed up in the current review supports the utility of patient education interventions that employ behavioural strategies tailored to the developmental needs of children, adolescents and young adults with different cultural backgrounds.
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Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Anne Trollvik
- Institute of Nursing, Faculty of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | | | | | - André Vågan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
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Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev 2019; 1:CD011651. [PMID: 30687940 PMCID: PMC6353176 DOI: 10.1002/14651858.cd011651.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes. OBJECTIVES This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses. SEARCH METHODS We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017. SELECTION CRITERIA Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control. DATA COLLECTION AND ANALYSIS We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ). MAIN RESULTS We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence). AUTHORS' CONCLUSIONS School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.
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Affiliation(s)
- Katherine Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vanessa M McDonald
- The University of NewcastleSchool of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory DiseaseLocked Bag 1000New LambtionNewcastleNSWAustralia2305
| | - Jonathan Grigg
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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Investigating Youth Sport Coach Perspectives of an Asthma Education Module. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:2512010. [PMID: 29971114 PMCID: PMC6008624 DOI: 10.1155/2018/2512010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/03/2018] [Indexed: 12/02/2022]
Abstract
Physical activity can reduce symptoms and improve wellbeing in people who have asthma, and organized sport is one way for children and youth with asthma to engage in exercise. While asthmatic youth may experience a number of barriers to sport participation, healthy physical and social sport environments supported by coaches can help asthmatic youth athletes maintain long-term engagement in activity. This paper reports results of an assessment of an online coach education tool related to air quality, physical activity, and allergic disease (e.g., asthma). Focus groups with youth team sport coaches in southern Ontario (n = 12 participants) were conducted to explore how users experience the module and short- and medium-term outcomes of implementation. Although coaches perceive the module as relevant, it is considered less valuable in certain contexts (e.g., indoor environments) or when compared with other coach education (e.g., tactical). Although broad asthma management behaviours (e.g., athlete medical forms) were recognized, specific module-identified prevention and management techniques (e.g., the Air Quality Health Index) were less frequently described. Ensuring environment and health coach education emphasizes athlete performance while reducing risk is critical to promoting module application and providing safe and enjoyable youth team sport spaces.
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Hughes D, Maiden K. Navigating the Health Care System: An Adolescent Health Literacy Unit for High Schools. THE JOURNAL OF SCHOOL HEALTH 2018; 88:341-349. [PMID: 29609216 DOI: 10.1111/josh.12616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 02/01/2017] [Accepted: 12/14/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Currently, no intervention concerning transition of health care responsibilities from parents to teens exists for adolescents in the general population. The purpose of this intervention was to evaluate teacher satisfaction and student knowledge gain of a health unit developed for adolescents on becoming their own health care advocates. METHODS Throughout the 2014-2015 school year, 13 health and career technical education teachers in 11 Delaware high schools taught the unit to 948 students in 2 90-minute classes in 35 classrooms. Assessments included teacher reflections and student pre- and posttests to measure knowledge transfer and gain and gather feedback. RESULTS Teacher and student feedback indicated the materials were appropriate and useful in teaching students to navigate the health care system. Student knowledge increased from pretest (64%) to posttest (82%), (p < .001). The educational background of the teacher did not influence this outcome. Students reported they will know what to do better at their next doctor's appointment because of this unit and indicated support for peers to learn this information. CONCLUSIONS The unit resulted in content knowledge increase for students. It was consistently effective throughout all schools regardless of social and demographic characteristics, teacher type, or experience teaching the unit.
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Affiliation(s)
- Denise Hughes
- Health & Prevention Services, Nemours Children's Health System, 1600 Rockland Road, Wilmington, DE 19803
| | - Kristin Maiden
- Health & Prevention Services, Nemours Children's Health System, 1600 Rockland Road, Wilmington, DE 19803
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Allen ED, Arcoleo K, Rowe C, Long WW. Implementation of a "real world" School-Based Asthma Therapy program targeting urban children with poorly controlled asthma. J Asthma 2017; 55:1122-1130. [PMID: 29190172 DOI: 10.1080/02770903.2017.1396472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States. METHODS A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years. A total of 286 students participated in the 2015-2016 school year. Kruskal-Wallis nonparametric testing compared Asthma Control Test™ (ACT) scores from enrollment (anytime between 2013 and 2015) to 2015-2016 for 198 students; and pre- and postenrollment asthma-related emergency department (ED), inpatient, and critical care (pediatric intensive care unit or PICU) utilization rates (events/student/year) for 98 students enrolled for a full year. RESULTS SBAT participation grew from 17 to 131 schools and from 38 to 268 students between 2013-2014 and 2015-2016. Mean ACT scores increased from 16.2 (SD = 4.89) to 21.37 (SD = 3.41) (K-W χ2 = 35.45, p = 0.008). Healthcare utilization rates from 1-year preenrollment to 1-year postenrollment decreased for ED (0.91-0.44; K-W χ2 = 18.61, p = 0.0002) and Inpatient (0.38-0.10; K-W χ2 = 7.68, p = 0.02). Reduction in PICU (0.27-0.02) was not statistically significant. CONCLUSIONS SBAT, modeled after programs shown in controlled trials to improve asthma health markers ( 1-3 ), was successfully implemented in economically challenged, urban schools. Rapid growth and patient reenrollment reflect program acceptance by schools, providers, and caregivers. Improved ACT scores and healthcare utilization supported program efficacy. SBAT could be one solution to improved asthma control in underserved school-aged pediatric patients.
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Affiliation(s)
- Elizabeth D Allen
- a Physician Lead, Asthma Quality Improvement, Nationwide Children's Hospital , Division of Pulmonary Medicine , Columbus , OH , USA
| | - Kimberly Arcoleo
- b Associate Professor & Associate Dean for Research , University of Rochester, School of Nursing , Rochester , NY , USA
| | - Courtney Rowe
- c School Based Asthma Therapy (SBAT) Program Nurse Practitioner , Nationwide Children's Hospital , Columbus , OH , USA
| | - William W Long
- d Associate Administrative Medical Director , Nationwide Children's Hospital , Columbus , OH , USA
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Tseng TJ, Chang AM, Wu CJJ. A randomized control trial of an asthma self-management program for adolescents in Taiwan: A study protocol. Contemp Clin Trials Commun 2017; 8:122-126. [PMID: 29696200 PMCID: PMC5898548 DOI: 10.1016/j.conctc.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022] Open
Abstract
Uncontrolled asthma in adolescents can be explained by developmental changes and lack of priority for self-care activities. Limited reports on asthma self-management programs for adolescents to enhance prevention behaviors in Taiwan were found. The protocol paper presents a two-armed, randomized controlled trial aiming to test the effectiveness of a newly developed self-management program for 112 adolescents with asthma in Taiwan. The primary outcome is asthma self-efficacy. Data will be collected at baseline and the week 4. The findings of this study will determine the extent to which a self-management program for adolescents with asthma in Taiwan enhances asthma management self-efficacy, self-management activities in asthma prevention and management, and achievement of well-controlled asthma. Trial Registration No: ACTRN12613001294741.
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Affiliation(s)
- Tzu-Jung Tseng
- Department of Nursing, Chang Gung University of Science and Technology, No.2, Sec. W., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan, ROC
| | - Anne M Chang
- Adjunct Professor, School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, Australia
| | - Chiung-Jung Jo Wu
- Associate Professor, School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast.,Visiting Fellow, School of Nursing, Queensland University of Technology, Brisbane, Australia.,Honorary Research Fellow, Royal Brisbane and Women's Hospital, Brisbane (RBWH), Australia.,Honorary Research Fellow, Mater Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia
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Building school health partnerships to improve pediatric asthma care: the School-based Asthma Management Program. Curr Opin Allergy Clin Immunol 2017; 17:160-166. [PMID: 28177950 DOI: 10.1097/aci.0000000000000347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children with asthma require care that is seamlessly coordinated so that asthma symptoms are recognized and managed at home and at school. The purpose of this review is to discuss recent consensus recommendations in school-based asthma care. RECENT FINDINGS The School-based Asthma Management Program (SAMPRO) provides a widely endorsed framework to coordinate care with schools and consists of four components: establishing a circle of support around the child with asthma; facilitating bidirectional communication between clinicians and schools; comprehensive asthma education for schools; and assessment and remediation of environmental asthma triggers at school. SAMPRO standardizes recommendations for school-based asthma care coordination and provides a toolkit with websites and resources useful for the care of children with asthma in the school setting. SUMMARY The review will discuss the need for coordinated school asthma partnerships, the inception and development of SAMPRO, and its vision to improve pediatric asthma care coordination within the circle of support, comprising clinicians, school nurses, families, and communities.
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Carpenter DM, Estrada RD, Roberts CA, Elio A, Prendergast M, Durbin K, Jones GC, North S. Urban-Rural Differences in School Nurses' Asthma Training Needs and Access to Asthma Resources. J Pediatr Nurs 2017; 36:157-162. [PMID: 28888497 PMCID: PMC6050021 DOI: 10.1016/j.pedn.2017.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Few studies have examined school nurses preferences' for asthma training. Our purpose was to: 1) assess school nurses' perceived asthma training needs, 2) describe nurses' access to asthma educational resources, and 3) identify urban-rural differences in training needs and access to resources in southern states. DESIGN AND METHODS A convenience sample of school nurses (n=162) from seven counties (two urban and five rural) in North Carolina and South Carolina completed an online, anonymous survey. Chi-square tests were used to examine urban-rural differences. RESULTS Although most nurses (64%) had received asthma training within the last five years, urban nurses were more likely to have had asthma training than rural nurses (χ2=10.84, p=0.001). A majority of nurses (87%) indicated they would like to receive additional asthma training. Approximately half (45%) of nurses reported access to age-appropriate asthma education materials, but only 16% reported that their schools implemented asthma education programs. Urban nurses were more likely than rural nurses to have access to asthma education programs (χ2=4.10, p=0.04) and age-appropriate asthma education materials (χ2=8.86, p=0.003). CONCLUSIONS Few schools are implementing asthma education programs. Rural nurses may be disadvantaged in terms of receiving asthma training and having access to asthma education programs and materials. PRACTICE IMPLICATIONS Schools are an ideal setting for delivering age-appropriate asthma education. By providing school nurses with access to age-appropriate asthma education resources and additional asthma training, we can help them overcome several of the barriers that impede their ability to deliver asthma care to their students.
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Affiliation(s)
- Delesha M Carpenter
- University of North Carolina, Eshelman School of Pharmacy (Asheville Satellite Campus), Asheville, NC, USA.
| | | | - Courtney A Roberts
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
| | - Alice Elio
- Mountain Area Health Education Center, Asheville, NC, USA.
| | | | - Kathy Durbin
- Lancaster County School District, Lancaster, SC, USA.
| | | | - Steve North
- Health-e-Schools, Center for Rural Health Innovation, Spruce Pine, NC, USA.
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Leroy ZC, Wallin R, Lee S. The Role of School Health Services in Addressing the Needs of Students With Chronic Health Conditions. J Sch Nurs 2017; 33:64-72. [PMID: 27872391 PMCID: PMC5654627 DOI: 10.1177/1059840516678909] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for students with limited access to health care. A systematic review to assess the role of school health services in addressing CHCs among students in Grades K-12 was completed using primary, peer-reviewed literature published from 2000 to 2015, on selected conditions: asthma, food allergies, diabetes, seizure disorders, and poor oral health. Thirty-nine articles met the inclusion criteria and results were synthesized; however, 38 were on asthma. Direct access to school nursing and other health services, as well as disease-specific education, improved health and academic outcomes among students with CHCs. Future research needs to include standardized definitions and data collection methods for students with CHCs.
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Affiliation(s)
- Zanie C. Leroy
- School Health Branch, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarah Lee
- School Health Branch, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mickel CF, Shanovich KK, Evans MD, Jackson DJ. Evaluation of a School-Based Asthma Education Protocol. J Sch Nurs 2016; 33:189-197. [PMID: 27450449 DOI: 10.1177/1059840516659912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-based asthma education offers an opportunity to reach low-income children at risk for poor asthma control. Iggy and the Inhalers (Iggy) is an asthma education program that was implemented in a Midwest metropolitan school district. The purpose of this evaluation was to conduct a comprehensive program evaluation. Objectives included increasing children's asthma-related knowledge and families' awareness of asthma management, while cultivating collaboration between school nurses and asthma providers. A total of 173 students participated in Iggy education, with 147 completing both initial and 1-month posttests. Thirty-one parents and seven school nurses provided qualitative feedback. Iggy was well received by children, parents, and school nurses. Asthma knowledge increased significantly ( p < .001) between pretest and posttest, and this increase was retained at 1-month follow-up. This program evaluation suggests that our program had a significant, sustained impact on students' asthma knowledge. It also supports the value of collaboration between asthma providers and school nurses.
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Affiliation(s)
- Catherine F Mickel
- 1 Marquette University, Milwaukee, WI, USA.,2 Department of Pediatrics, Denver Health Medical Center, Denver, CO, USA
| | - Kathleen K Shanovich
- 3 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Michael D Evans
- 3 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Daniel J Jackson
- 4 Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Liptzin DR, Gleason MC, Cicutto LC, Cleveland CL, Shocks DJ, White MK, Faino AV, Szefler SJ. Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:972-979.e1. [PMID: 27283054 DOI: 10.1016/j.jaip.2016.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma is a significant health problem among children: 9.3% of children in the United States suffer from asthma. Children with persistent asthma in inner cities have increased health care utilization, worse health care outcomes, increased school absences, and worse academic performance. OBJECTIVE We sought to create and evaluate a school-centered asthma program to reduce asthma morbidity and create asthma-friendly schools. METHODS We developed, implemented, and evaluated the Step-Up Asthma Program, a multidisciplinary school-centered asthma program. The program was designed as an outreach program with asthma counselors as a bridge between subspecialty asthma care, primary care providers, school nurses, and children with asthma. The core components of the program involve identifying children with asthma, providing evidence-based asthma education, and case management. Students' asthma knowledge, inhaler technique, and number of asthma exacerbations were evaluated over a 2-year period (2010-2012) as a pre-post study. RESULTS A total of 252 students enrolled in the Step-Up Asthma Program over a 2-year period. Significant improvements were noted in number of asthma action plans, rescue medications at school, and asthma controllers. Program participants had significant improvements in asthma knowledge scores (P < .001) and inhaler technique (P < .0001). There were significant reductions in asthma exacerbations defined as oral steroid courses, urgent care visits, and missed school days (P < .05) that persisted over time. CONCLUSIONS A guideline-based school-centered asthma program can significantly reduce asthma morbidity. The asthma counselor is the cornerstone of the program, providing asthma education and care coordination. The Step-Up Asthma Program is in its 10th year, and we believe the key elements of this program can be implemented in other school systems.
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Affiliation(s)
- Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Melanie C Gleason
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Lisa C Cicutto
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Department of Medicine, National Jewish Health, Denver, Colo
| | | | | | - Martha K White
- The Breathing Institute, Children's Hospital Colorado, Aurora, Colo; Denver Public Schools, Denver, Colo
| | - Anna V Faino
- Department of Medicine, National Jewish Health, Denver, Colo
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; The Breathing Institute, Children's Hospital Colorado, Aurora, Colo.
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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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Mosnaim GS, Pappalardo AA, Resnick SE, Codispoti CD, Bandi S, Nackers L, Malik RN, Vijayaraghavan V, Lynch EB, Powell LH. Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:130-41. [PMID: 26563672 DOI: 10.1016/j.jaip.2015.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/19/2015] [Accepted: 09/18/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. OBJECTIVE This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. METHODS A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. RESULTS Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. CONCLUSIONS Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.
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Affiliation(s)
- Giselle S Mosnaim
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill.
| | | | | | | | - Sindhura Bandi
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Ill
| | - Lisa Nackers
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
| | - Rabia N Malik
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
| | | | - Elizabeth B Lynch
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
| | - Lynda H Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Ill
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24
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Establishing school-centered asthma programs. J Allergy Clin Immunol 2015; 134:1223-1230. [PMID: 25482867 DOI: 10.1016/j.jaci.2014.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/07/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
Asthma is a common chronic childhood disease associated with significant morbidity and high rates of school absenteeism, along with excessive costs for the patient and society. Asthma is a leading cause of school absenteeism, but this absenteeism is not equally distributed among those with asthma. Second to their home, school-aged children spend the largest portion of their wakeful hours at school. Opportunities exist to partner with schools to reach most children with asthma and those at the highest risk for asthma burden and in need of assistance. Asthma management at schools is important for pediatric pulmonologists and allergists, primary care providers, and the whole interdisciplinary team working alongside them to provide quality asthma care. The variability of asthma care services and programs provided in schools should prompt clinicians to understand their own school system and to advocate for appropriate services. Models of asthma care that place schools at the center or core of the model and coordinate evidence-based asthma care are applicable nationwide and might serve as a model for managing other chronic illnesses.
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Reznik M, Jaramillo Y, Wylie-Rosett J. Demonstrating and assessing metered-dose inhaler-spacer technique: pediatric care providers' self-reported practices and perceived barriers. Clin Pediatr (Phila) 2014; 53:270-6. [PMID: 24336438 DOI: 10.1177/0009922813512521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler-spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient's asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed.
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Abstract
The Student Asthma Research Team (START) program was designed to enable students to explore socio-ecological factors contributing to asthma through the use of Photovoice, a technique that gathers both photographs and personal experiences from participants. The photographs taken by and commentary from student participants were integrated into public service announcements (PSAs) intended to increase community asthma awareness and catalyze behavior change. This article evaluates the effectiveness of these student-directed PSAs at improving asthma awareness among peers and community members. Pre-PSA, immediate post-PSA, and 4 month post-PSA follow-up assessments were conducted to evaluate changes in community members' asthma knowledge and behavior. The student-directed PSAs were found to significantly increase asthma knowledge among community members, irrespective of age, gender, or race. Increased knowledge persisted through the 4-month post-PSA follow-up. Of the thirty-six participants who were successfully contacted for the follow-up survey, nearly 40 % reported meaningful behavior-change in response to the PSAs. Photovoice and media production techniques were effective in engaging adolescent students--an under-served and often disenfranchised population--in asthma health education through the development and dissemination of PSAs. The extension of participatory techniques such as Photovoice to include the creation of student-directed PSAs holds promise for engaging adolescents in public health initiatives within their communities.
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Carpenter LM, Lachance L, Wilkin M, Clark NM. Sustaining school-based asthma interventions through policy and practice change. THE JOURNAL OF SCHOOL HEALTH 2013; 83:859-866. [PMID: 24261520 DOI: 10.1111/josh.12104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Schools are an ideal setting for implementation of asthma interventions for children; however, sustaining school-based programs can be challenging. This study illustrates policy and practice changes brought about through the Childhood Asthma Linkages in Missouri (CALM) program to sustain such programs. METHODS Researchers analyzed caregiver-reported quantitative data regarding asthma-related outcomes in preintervention and postintervention surveys and qualitative data regarding sustainability efforts in schools reported by CALM grantees. A grounded theory approach was used to identify key concepts and themes that emerged. RESULTS In 330 children, significant improvements were seen in asthma symptoms, rescue inhaler use, health care utilization, school absenteeism, and activity limitations. Overall, 27 school-based policy and practice changes supporting program sustainability were reported, with policy changes most often concerning the assessment and/or monitoring of children with asthma in the school setting, and practice changes most often regarding institution of regular asthma education programs for students and school personnel. CONCLUSIONS Sustaining school-based asthma programs is challenging, but can be realized through the participation of diverse partners in enacting policy and practice changes that support the institutionalization of programs into the day-to-day processes of the schools.
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Affiliation(s)
- Laurie M Carpenter
- Senior Research Associate, , Center for Managing Chronic Disease, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109
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28
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Zarei S, Valizadeh L, Bilan N. The Effect of Educational and Modifying Intervention on Asthma Control among Adolescents: a Randomized Clinical Trial. J Caring Sci 2013; 2:73-82. [PMID: 25276712 DOI: 10.5681/jcs.2013.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/15/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Controlling over allergens and environmental irritants is one of the essential elements of controlling asthma. Asthma control in adolescents is a challenge. The current study was performed with the goal of investigating the effect of an educational and modifying intervention about asthma triggers on asthma control among adolescents. METHODS The current study was a randomized clinical trial. 60 adolescents of 12-18 years of age participated in this study. The participants were randomly divided into the two control and experimental groups. The Juniper's Asthma Control Questionnaire was completed by the adolescents before and 5 weeks after the intervention. Training sessions, planning for modification of asthma triggers and telephone follow-up were performed in the experimental group. RESULTS There was a significant difference between the asthma control score before and after the intervention in the control and experimental groups. The asthma control status improved in the experimental group. In other words, the educational interventions to modify asthma triggers were effective in improving asthma control. CONCLUSION Since this intervention method can improve the asthma control in adolescents, it is recommended that adolescents directly participate in such programs about asthma triggers and the education become less parent-centred. Moreover, the necessity of such an intervention in clinics and outpatient clinics is emphasized.
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Affiliation(s)
- Soheila Zarei
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nemat Bilan
- Department of Pediatric, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Gupta RS, Lau CH, Springston EE, Warren CM, Mears CJ, Dunford CM, Sharp LK, Holl JL. Perceived Factors Affecting Asthma Among Adolescents. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2150129712472342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year in an inner-city Chicago high school with high asthma rates and poor asthma morbidity. Students met after school twice a week over 10 weeks. Students were given basic training in research and media production using photovoice participatory research technique and were instructed to identify personally relevant factors affecting asthma through photography and journaling. Students’ journal entries and photographs were qualitatively coded. Relative frequencies of codes were calculated to determine common themes among identified factors. Students worked with a videographer to compile their findings into informational videos, which were used to educate peers and community members about asthma. Results: Fifteen students aged 13 to 18 attended a mean of 11 sessions (out of 20). One hundred eighty photographs (mean = 12 per student) and 112 journal entries (mean = 7.5 per student) were reviewed, with 4 predominant positive and negative factors identified. Reported factors influencing students’ health and asthma included social support (22% of student photos and journal entries), neighborhood environment (17%), and lifestyle (28%), in addition to well-established asthma factors (43%). Conclusions: Results from the Student Asthma Research Team pilot demonstrate that adolescent students, given appropriate instruction and opportunity, are able to identify factors affecting their asthma. Interventions engaging adolescents via self-directed identification and participatory media production techniques hold promise as vehicles for enabling students to own and share health-related experiences through research and peer/community outreach.
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Affiliation(s)
- Ruchi S. Gupta
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Claudia H. Lau
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Elizabeth E. Springston
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christopher M. Warren
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Cynthia J. Mears
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christine M. Dunford
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Lisa K. Sharp
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Jane L. Holl
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
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Mammen J, Rhee H. Adolescent Asthma Self-Management: A Concept Analysis and Operational Definition. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:180-189. [PMID: 23285426 DOI: 10.1089/ped.2012.0150] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/15/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND: Adolescents with asthma have a higher risk of morbidity and mortality than other age groups. Asthma self-management has been shown to improve outcomes; however, the concept of asthma self-management is not explicitly defined. METHODS: We use the Norris method of concept clarification to delineate what constitutes the concept of asthma self-management in adolescents. Five databases were searched to identify components of the concept of adolescent asthma self-management, and lists of relevant subconcepts were compiled and categorized. RESULTS: Analysis revealed 4 specific domains of self-management behaviors: (1) symptom prevention; (2) symptom monitoring; (3) acute symptom management; and (4) communication with important others. These domains of self-management were mediated by intrapersonal/cognitive and interpersonal/contextual factors. CONCLUSIONS: Based on the analysis, we offer a research-based operational definition for adolescent asthma self-management and a preliminary model that can serve as a conceptual base for further research.
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Affiliation(s)
- Jennifer Mammen
- School of Nursing, University of Rochester , Rochester, New York
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31
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Masuda JR, Anderson S, Letourneau N, Sloan Morgan V, Stewart M. Reconciling preferences and constraints in online peer support for youth with asthma and allergies. Health Promot Pract 2012; 14:741-50. [PMID: 23171653 DOI: 10.1177/1524839912465083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Srof B, Taboas P, Velsor-Friedrich B. Adolescent asthma education programs for teens: review and summary. J Pediatr Health Care 2012; 26:418-26. [PMID: 23099308 DOI: 10.1016/j.pedhc.2011.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/18/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this review is to describe and evaluate education programs for teens with asthma. Although asthma educational programs for children are plentiful, this is not the case for adolescents. The developmental tasks of adolescence require asthma education programs that are uniquely tailored to this age group. Although several well-designed studies appear in the literature, further research is needed to evaluate the efficacy of asthma education programs among teens. Although the quality of research varies, demonstrated program benefits include improved asthma self-management, self-efficacy, family support mechanisms, and quality of life. Practice implications point to the need for education programs in schools and camp settings that are consistent with national asthma guidelines.
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Kim O, Kim BH. Association of asthma symptoms with cigarette smoking and alcohol consumption in Korean adolescents. Nurs Health Sci 2012; 15:65-72. [PMID: 23094961 DOI: 10.1111/j.1442-2018.2012.00737.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/18/2012] [Accepted: 08/05/2012] [Indexed: 10/27/2022]
Abstract
The association of asthma symptoms with cigarette smoking and alcohol consumption in Korean adolescents was investigated in this study using the data of Korean Youth Risk Behavior Survey. Associated risk factors for experiencing asthma symptoms were explored in 3432 adolescents. In the symptomatic group, 21.7% were current smokers, compared to 10.9% in the asymptomatic group. Current smokers in the symptomatic group also smoked more cigarettes than those in the asymptomatic group. In the symptomatic group, 27.4% were current drinkers, compared to 17.9% in the asymptomatic group. Current drinkers in the symptomatic group were more likely to drink alcohol and to have experienced severe intoxication than those in the asymptomatic group. Participants who had been diagnosed within one year (odds ratio = 5.19, 95% confidence interval = 4.17-6.44) and those who had smoked over 20 days during the past 30 days (odds ratio = 1.77, 95% confidence interval = 1.26-2.49) were more likely to experience asthma symptoms. Healthcare providers should identify the risk behaviors of adolescents with asthma and counsel them and their parents simultaneously.
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Affiliation(s)
- Oksoo Kim
- Division of Nursing Science, Ewha WomansUniversity, Sudaemun-gu, Seoul, Korea.
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34
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Hennessy-Harstad E. Asthma and adolescents: review of strategies to improve control. J Sch Nurs 2012; 29:39-51. [PMID: 22815347 DOI: 10.1177/1059840512454546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of every 10 adolescents in the United States has asthma. Adolescents who lack asthma control are at increased risk for severe asthma episodes and death. The National Heart, Lung, and Blood Institute 2007 asthma guidelines and research studies indicated that school nurses are instrumental in assisting adolescents to monitor their asthma, learn asthma self-management skills, and improve health outcomes. This integrative review examines the research from 2005 to 2011 to identify strategies for school nurses to employ with adolescents to foster self-management skills. The research reviewed here supports the need for school nurses to engage adolescents with asthma to practice self-management behaviors. They should educate the adolescent for asthma, monitor how well the adolescent controls asthma, manage acute asthma episodes by using an asthma action plan, and coordinate care by obtaining written consent from parents to share health information with health care providers.
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Kintner E, Cook G, Allen A, Meeder L, Bumpus J, Lewis K. Feasibility and benefits of a school-based academic and counseling program for older school-age students with asthma. Res Nurs Health 2012; 35:507-17. [PMID: 22644890 DOI: 10.1002/nur.21490] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2012] [Indexed: 11/06/2022]
Abstract
An asthma education program for older school-age students with asthma was developed in collaboration with school personnel, healthcare professionals, and community partners. Feasibility and benefits were evaluated using a single-group, prospective, quasi-experimental design. The convenience sample, consisting of 28 grade 6 and 7 students with asthma, had 50% males, a diverse racial background, and a wide range of incomes. Feasibility and benefits were demonstrated by comparing pre-intervention to 1- and 12-month post-intervention evaluation of students who completed more than 70% of the 10 sessions. Statistically significant improvements in cognitive, behavioral, psychosocial, and quality of life outcomes were seen from pre-intervention to 1-month post-intervention (all p < .03). Severity of asthma significantly improved from 1- to 12-month post-intervention (p= .04).
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Affiliation(s)
- Eileen Kintner
- The University of Texas at Austin School of Nursing, Austin, TX 8701-1499, USA
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Brandt SJ, Perez L, Künzli N, Lurmann F, McConnell R. Costs of childhood asthma due to traffic-related pollution in two California communities. Eur Respir J 2012; 40:363-70. [PMID: 22267764 DOI: 10.1183/09031936.00157811] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent research suggests the burden of childhood asthma that is attributable to air pollution has been underestimated in traditional risk assessments, and there are no estimates of these associated costs. We aimed to estimate the yearly childhood asthma-related costs attributable to air pollution for Riverside and Long Beach, CA, USA, including: 1) the indirect and direct costs of healthcare utilisation due to asthma exacerbations linked with traffic-related pollution (TRP); and 2) the costs of health care for asthma cases attributable to local TRP exposure. We calculated costs using estimates from peer-reviewed literature and the authors' analysis of surveys (Medical Expenditure Panel Survey, California Health Interview Survey, National Household Travel Survey, and Health Care Utilization Project). A lower-bound estimate of the asthma burden attributable to air pollution was US$18 million yearly. Asthma cases attributable to TRP exposure accounted for almost half of this cost. The cost of bronchitic episodes was a major proportion of both the annual cost of asthma cases attributable to TRP and of pollution-linked exacerbations. Traditional risk assessment methods underestimate both the burden of disease and cost of asthma associated with air pollution, and these costs are borne disproportionately by communities with higher than average TRP.
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Affiliation(s)
- Sylvia J Brandt
- Resource Economics and Center for Public Policy and Administration 205 Stockbridge Hall, University of Massachusetts, Amherst, MA 01003, USA.
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Nabors LA, Kockritz JL, Ludke RL, Bernstein JA. Enhancing school-based asthma education efforts using computer-based education for children. J Asthma 2012; 49:209-12. [PMID: 22211479 DOI: 10.3109/02770903.2011.645181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Schools are an important site for delivery of asthma education programs. Computer-based educational programs are a critical component of asthma education programs and may be a particularly important education method in busy school environments. OBJECTIVE The objective of this brief report is to review and critique computer-based education efforts in schools. RESULTS The results of our literature review indicated that school-based computer education efforts are related to improved knowledge about asthma and its management. In some studies, improvements in clinical outcomes also occur. Data collection programs need to be built into games that improve knowledge. Many projects do not appear to last for periods greater than 1 year and little information is available about cultural relevance of these programs. CONCLUSIONS Educational games and other programs are effective methods of delivering knowledge about asthma management and control. Research about the long-term effects of this increased knowledge, in regard to behavior change, is needed. Additionally, developing sustainable projects, which are culturally relevant, is a goal for future research.
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Affiliation(s)
- Laura A Nabors
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH, USA.
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Bruzzese JM, Stepney C, Fiorino EK, Bornstein L, Wang J, Petkova E, Evans D. Asthma self-management is sub-optimal in urban Hispanic and African American/black early adolescents with uncontrolled persistent asthma. J Asthma 2011; 49:90-7. [PMID: 22149141 DOI: 10.3109/02770903.2011.637595] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Youth as young as 11 are given responsibility to manage their asthma. Yet, little is known regarding early adolescents' asthma self-management behaviors. This study characterizes urban early adolescents' asthma self-management behaviors and perceived responsibility to manage asthma, exploring demographic differences and examining the relationship between asthma responsibility and disease management. METHODS About 317 Hispanic and African American/Black early adolescents (mean age = 12.71) with persistent, uncontrolled asthma reported prevention and symptom management steps, and responsibility for asthma care. We used Poisson, cumulative logistic, logistic, and linear mixed-effects regression models to assess the relationships among demographic predictors, prevention and management behaviors, and responsibility for asthma care. RESULTS Fifty percent took 7-9 prevention steps; few saw physicians when asymptomatic or took daily medication. When symptomatic, 92% used medication to treat symptoms and 56% sought medical attention. Controlling for asthma responsibility, fewer older youth reported observing how they feel when asthma is likely to start, observing symptom changes, or asking for help. More boys reported taking medication daily or upon trigger exposure. Controlling for age, gender, and race/ethnicity, those reporting more asthma responsibility were less likely to report taking management steps, seeking preventive care, asking for help, or going to a doctor/hospital for their asthma. CONCLUSIONS Early adolescents' asthma self-management is suboptimal. With increasing age, they are less observant regarding their asthma and less likely to seek help. Although they perceive themselves to have greater responsibility for managing their asthma, early adolescents do less to care for their asthma, suggesting they are being given responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York University School of Medicine, New York, NY 10016, USA.
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Mosnaim GS, Li H, Damitz M, Sharp LK, Li Z, Talati A, Mirza F, Richardson D, Rachelefsky G, Africk J, Powell LH. Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers. Ann Allergy Asthma Immunol 2011; 107:310-6. [PMID: 21962090 DOI: 10.1016/j.anai.2011.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 06/23/2011] [Accepted: 07/20/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND School-based asthma education programs targeting disadvantaged youth and teens with asthma are lacking. OBJECTIVES To assess the impact of the Fight Asthma Now (FAN) educational program among 2 populations of predominantly low-income minority students: youth (3(rd)-6(th) graders) and teens (7(th)-8(th) graders). METHODS Chicago-area elementary schools were invited to participate in this stratified 2-arm study. Eligible schools were assigned to participate either in the intervention or in the control arm. Within each participating school, eligible students were recruited and grouped (stratified by grade and age) to form teen or youth classes. Participants completed a pre- and post-intervention asthma knowledge questionnaire and observation for spacer technique competency. The treatment group received the FAN curriculum between the evaluations. RESULTS A sample of 26 low-income, predominantly minority-serving schools was recruited. Most participating schools were randomized in a 3:1 ratio to form 25 youth classes (19 intervention and 6 control group) and 16 teen classes (11 intervention and 5 control group), resulting in 275 vs 69 youth and 141 vs 51 teens in the intervention and control groups, respectively. Stratified analyses were performed, and clustering within the school and class was taken into consideration in analyses. Multilevel models adjusting for school, class, ethnicity, sex, and pretest score indicate that the FAN intervention significantly increased both knowledge and spacer competency test scores, among both the youth and teen participants (P = .011 with respect to knowledge score among teen students, P < .0001 for all other cases). CONCLUSIONS This study suggests that FAN significantly increases asthma knowledge and spacer technique competency within this high-risk population.
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Affiliation(s)
- Giselle S Mosnaim
- Department of Preventive Medicine, Rush Medical College, Chicago, Illinois 60612, USA.
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Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B. A pilot study to enhance preventive asthma care among urban adolescents with asthma. J Asthma 2011; 48:523-30. [PMID: 21599562 DOI: 10.3109/02770903.2011.576741] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications. OBJECTIVE To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity. DESIGN/METHODS SUBJECTS/SETTING Teens with persistent asthma and a current preventive medication prescription in Rochester, NY. DESIGN Single group pre-post pilot study during the 2009-2010 school year. INTERVENTION Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year. RESULTS We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again. CONCLUSIONS This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Halterman JS, Szilagyi PG, Fisher SG, Fagnano M, Tremblay P, Conn KM, Wang H, Borrelli B. Randomized controlled trial to improve care for urban children with asthma: results of the School-Based Asthma Therapy trial. ACTA ACUST UNITED AC 2011; 165:262-8. [PMID: 21383275 DOI: 10.1001/archpediatrics.2011.1] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma. DESIGN Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-based care group or a usual care control group. SETTING Rochester, New York. PARTICIPANTS Children aged 3 to 10 years with persistent asthma. INTERVENTIONS Directly observed administration of daily preventive asthma medications by school nurses (with dose adjustments according to National Heart, Lung, and Blood Institute Expert Panel guidelines) and a home-based environmental tobacco smoke reduction program for smoke-exposed children, using motivational interviewing. MAIN OUTCOME MEASURE Mean number of symptom-free days per 2 weeks during the peak winter season (November-February), assessed by blinded interviews. RESULTS We enrolled 530 children (74% participation rate). During the peak winter season, children receiving preventive medications through school had significantly more symptom-free days compared with children in the control group (adjusted difference = 0.92 days per 2 weeks; 95% confidence interval, 0.50-1.33) and also had fewer nighttime symptoms, less rescue medication use, and fewer days with limited activity (all P < .01). Children in the treatment group also were less likely than those in the control group to have an exacerbation requiring treatment with prednisone (12% vs 18%, respectively; relative risk = 0.64; 95% confidence interval, 0.41-1.00). Stratified analyses showed positive intervention effects even for children with smoke exposure (n = 285; mean symptom-free days per 2 weeks: 11.6 for children in the treatment group vs 10.9 for those in the control group; difference = 0.96 days per 2 weeks; 95% confidence interval, 0.39-1.52). CONCLUSIONS The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642, USA.
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Srof BJ, Velsor-Friedrich B, Penckofer S. The effects of coping skills training among teens with asthma. West J Nurs Res 2011; 34:1043-61. [PMID: 21511980 DOI: 10.1177/0193945911406290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This pilot study used a pretest and posttest design to examine the effect of a school-based intervention, Coping Skills Training, among teens with asthma (N = 39) aged 14 to 18 years randomly assigned to treatment and control groups from three midwestern high schools. Variables included asthma self-efficacy, social support, asthma-related quality of life, peak expiratory flow rate, asthma diary symptoms, and rescue medication usage. The treatment group scored significantly higher on self-efficacy (p < .001), activity-related quality of life (p = .05), and social support (p < .001) compared with the control group after using ANCOVA to adjust for baseline scores. Significant improvements were also noted from pre- to posttest in the treatment group for self-efficacy (p < .001) and quality of life (p = .02). This study indicates that Coping Skills Training is an important intervention for further study with teens with asthma.
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Affiliation(s)
- Brenda J Srof
- Graduate Program in Nursing, Goshen College, IN 46526, USA.
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Stewart M, Masuda JR, Letourneau N, Anderson S, Cicutto L, McGhan S, Watt S. Online Support Intervention for Adolescents With Asthma and Allergies. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/2150129711402686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Miriam Stewart
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Jeffrey R. Masuda
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Nicole Letourneau
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Sharon Anderson
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Lisa Cicutto
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Shawna McGhan
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
| | - Susan Watt
- University of Alberta, Edmonton, Alberta (MS, SA)
- University of Manitoba, Winnipeg, Manitoba (JRM)
- University of New Brunswick, Fredericton, New Brunswick (NL)
- University of Toronto, Toronto, Ontario (LC)
- Alberta Asthma Centre, Edmonton, Alberta (SM)
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Ahmad E, Grimes DE. The effects of self-management education for school-age children on asthma morbidity: a systematic review. J Sch Nurs 2011; 27:282-92. [PMID: 21478414 DOI: 10.1177/1059840511403003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and targeted children 5-18 years of age were reviewed. The studies were all published between 1998 and 2009. The school-based asthma education programs delivered interventions in multiple sessions over short consecutive time periods of about a month to a month and a half. Follow-up data were collected in varying intervals from 1 month to 1 year postinterventions. Results indicated that a decrease in school days missed can be expected from such programs. The data regarding emergency department visits and hospital admissions was less definitive.
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Affiliation(s)
- Emily Ahmad
- Houston School of Nursing, University of Texas Health Science Center, USA.
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Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol 2011; 105:274-281. [PMID: 20934626 DOI: 10.1016/j.anai.2010.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/15/2010] [Accepted: 07/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Breathmobile, a specialty-based mobile asthma clinic, provides free care to underserved children. The cost of symptom-free day (SFD) improvement in this population has not been previously reported. OBJECTIVE To examine the clinical impact and cost-effectiveness of the Baltimore Breathmobile. METHODS Existing computerized data were analyzed for Breathmobile patient visits between 2002 and 2007. All SFDs were calculated, and direct medical cost savings attributable to decreased emergency department visits and hospitalizations (after program utilization vs the previous year) were compared with annual operating costs. Incremental cost-effectiveness ratios were determined by calculating the incremental costs of Breathmobile care per additional SFD gained per child per year. RESULTS The analysis included 255 patients enrolled in the program for at least 1 year. Most participants were black (93.3%), and 54.9% were male. At baseline, patients reported a mean (SD) of 199 (118) SFDs in the year before enrollment. After 1 year in the program, patients had a mean (SD) improvement of 44 (9) SFDs. The program resulted in overall cost savings of $79.43 per SFD gained, with greater cost savings for children aged 5 to 11 years (-$116.84 per SFD gained) and those with intermittent asthma (-$126.71 per SFD gained). CONCLUSIONS The Baltimore Breathmobile program has demonstrated significant improvement in SFDs, with direct medical cost savings of the program outweighing the operational costs. These data support the need to continue to sustain and expand Breathmobile programs for children at high risk for asthma exacerbations and to conduct a randomized clinical trial to estimate the cost-effectiveness of the Breathmobile.
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Affiliation(s)
- Mary Elizabeth Bollinger
- Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Herman EJ, Garbe PL, McGeehin MA. Assessing community-based approaches to asthma control: the Controlling Asthma in American Cities Project. J Urban Health 2011; 88 Suppl 1:1-6. [PMID: 21337047 PMCID: PMC3042071 DOI: 10.1007/s11524-010-9480-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elizabeth J Herman
- Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Patel Shrimali B, Hasenbush A, Davis A, Tager I, Magzamen S. Medication use patterns among urban youth participating in school-based asthma education. J Urban Health 2011; 88 Suppl 1:73-84. [PMID: 21337054 PMCID: PMC3042074 DOI: 10.1007/s11524-010-9475-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin' Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when "feeling symptoms" (p < 0.001), 41.6% of students reporting inappropriate medication use "before exercise" initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when "feeling fine" initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity.
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Affiliation(s)
- Bina Patel Shrimali
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
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Clayton S, Chin T, Blackburn S, Echeverria C. Different setting, different care: integrating prevention and clinical care in school-based health centers. Am J Public Health 2010; 100:1592-6. [PMID: 20634447 DOI: 10.2105/ajph.2009.186668] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
School-based health centers (SBHCs) are widely credited with increasing students' access to care by making health services affordable and convenient. SBHCs can also provide a qualitatively different type of health care for children and adolescents than that delivered by community providers. Health services offered in a school setting can integrate clinical care with public health interventions and environmental change strategies. This ability to reach outside the walls of the exam room makes SBHCs uniquely positioned to address the multiple determinants of health. We describe innovative California SBHC programs focusing on obesity prevention, asthma, mental health, and oral health that represent new models of health care for children and adolescents.
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Affiliation(s)
- Serena Clayton
- California School Health Centers Association, 660 13th St, Ste 202, Oakland, CA 94612, USA.
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Shendell DG, Alexander MS, Sanders DL, Jewett A, Yang J. Assessing the potential influence of asthma on student attendance/absence in public elementary schools. J Asthma 2010; 47:465-72. [PMID: 20528603 DOI: 10.3109/02770901003734298] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Student health, well-being, and productivity are determined in part by attending school daily. Increased annual average daily attendance (ADA) increases public funding for school district-based enrichment programs. Asthma is reported as the number 1 cause of American school absenteeism due to chronic illness; however, only limited, estimated national data exist. Accurate, precise ways to assess potential disparities in disease-driven absence do not yet exist. The authors summarize part of their community-based participatory research (CBPR), namely planning then testing a set of matching field sheet (data collection) and computer-based spreadsheets (database) based on previous school-based research to track attendance and reasons for absence. METHODS The CBPR process occurred mid-2005 to mid-2008, with final activities in DeKalb County, Georgia, August-December 2007 (fall semester) for this portion. The authors tracked absence, with an ability to examine data overall and at classroom, grade, and school levels by gender, race/ethnicity, and doctor-diagnosed asthma as reported to schools on student emergency cards. RESULTS The authors characterized their study sample, consisting of 914 4th-5th grade children (overall, 9.2% of children with asthma) from seven randomly selected, consenting participating schools (n = 21 classrooms per grade, 2 to 4 classrooms per grade per school). Six schools used paper versions of tools while one school used electronic versions. The authors presented attendance results in various aggregated manners. Absence was higher (ADA lower) among 4th grade asthmatic students compared to the entire classroom. CONCLUSIONS This study can inform future interdisciplinary school-based research combining health and student academic productivity, adult work performance outcomes, and other measures.
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Affiliation(s)
- Derek G Shendell
- Department of Environmental and Occupational Health Sciences, University of Medicine and Dentistry of New Jersey School of Public Health, Piscataway, New Jersey 08854, USA.
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Abstract
PURPOSE OF REVIEW Despite overall improvements in asthma care through an increasing evidence base, disparities in outcomes of children of ethnic minorities and low socioeconomic status are well documented across healthcare systems. New interventions to reduce gaps in outcomes among these children are continually being evaluated. This article reviews the most relevant and influential recent studies. RECENT FINDINGS A number of interventions aimed at vulnerable children with asthma have been successful. Most of these include a component of education and self-management. There is some evidence that culturally competent care produces improved outcomes, whereas stronger evidence exists for multifaceted programs and community health workers providing home visits for education and environmental allergen reduction. Targeting children and families through school-based programs may be an effective outreach strategy. Use of novel technologies such as educational messages on MP3 players shows promise in reaching at-risk adolescents. SUMMARY There are promising strategies proven to significantly decrease disparities in asthma among vulnerable children. Further research must be performed to elucidate the interventions that produce the greatest impact on asthma-related outcomes while being feasible, sustainable, and cost-effective.
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