The Asthma Belief Survey: Development and Testing

How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions

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.

Efficacy of the I Can Control Asthma and Nutrition Now (ICAN) pilot program on health outcomes in high school students with asthma

Asthma is the most prevalent chronic illness in childhood affecting 7 million youth. Many youth with asthma face another risk factor in obesity. Obesity, in turn, increases disorders such as asthma. Studies have recommended that asthma programs also address weight management in youth. Taking this into consideration, the I Can Control Asthma and Nutrition Now (ICAN) program is an innovative school-based program composed of (1) nutrition and weight management education, (2) asthma education, and (3) monthly reenforcement visits. This pilot study tested the initial effectiveness of the ICAN pilot program on a variety of asthma and nutrition outcomes in 25 urban minority students with asthma. Over the course of the pilot program, significant increases in asthma knowledge, asthma self-efficacy, asthma quality of life, asthma self-care, nutrition knowledge, nutrition self-efficacy, and asthma control were observed. The ICAN program has demonstrated promising preliminary results in improving nutrition and asthma health outcomes with urban minority high school students.

Accommodations and Therapeutic Techniques Used during the Administration of the Child Occupational Self Assessment

Introduction:

Paediatric occupational therapists can elicit children's perspectives and provide children with the opportunity to participate in decision making by administering self-reports. This study sought to identify the techniques that practitioners used to foster the effective and appropriate administration of one occupational therapy self-report, the Child Occupational Self Assessment (COSA).

Method:

Focus groups were held in the United States and the United Kingdom to explore therapists' experiences using the COSA. Thirty-three clinicians, including 28 occupational therapists, participated across five focus groups. Descriptive codes were generated using line-by-line coding, and codes were refined and reorganised using a constant comparative approach and triangulation with multiple coders.

Findings:

Therapists used two main techniques while administering the COSA: providing accommodations and interacting with clients in a therapeutic manner. Occupational therapists provided accommodations by adapting or adjusting the administration of the COSA to meet the individual needs of clients better. Therapists enacted a therapeutic use of self by developing rapport and empowering children during the administration process.

Conclusion:

This study illustrates that therapists use multiple therapeutic techniques aligned with the literature during the process of administering the COSA self-report. Further, those therapeutic techniques are enhanced by the simultaneous use of accommodations that ensure children are able to access and complete self-reports.

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

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

The effects of coping skills training among teens with asthma

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.

Helping African American children self-manage asthma: the importance of self-efficacy

BACKGROUND

Asthma is the leading cause of chronic illness among children in the United States, with a disproportionately higher incidence among minority children. In an attempt to increase understanding of the factors that may influence self-management of chronic disease, the study examined the relationship between self-efficacy belief and asthma self-management in urban African American children.

METHODS

Using a descriptive correlational research design, the participants (81 African American children between 7 and 12 years old) completed the Asthma Inventory for Children (AIC), which measured asthma self-management behaviors, and Asthma Belief Survey (ABS), which measured asthma self-efficacy.

RESULTS

Results of this study demonstrated a statistically positive correlation (p < .01, r = .53) between the child's asthma self-management and the child's self-efficacy belief toward his or her asthma. The mean item scores for the AIC, which measures the number of asthma management behaviors utilized by the participants, ranged from 1.88 to 5.00 with a mean of 3.69 and a standard deviation of 0.59. The mean scores of the ABS, which measures the level of self-efficacy beliefs for asthma management among the participants, ranged from 1.73 to 5.00 with a standard deviation of 0.58.

CONCLUSIONS

In chronic illness such as asthma, self-management is key to the long-range personal, academic, and professional success of children and adults with such conditions. Implications are drawn for the preparation of health care providers, teachers, and counselors who work with school-age children with asthma.

The development of building wellness™, a youth health literacy program

Health literacy research has concentrated on adults; there has been inadequate research on youth health literacy and the effect it may have on health outcomes. Low-income, minority populations have low levels of health literacy and are at higher risk of illness and disease. Building Wellness™ is a youth health literacy curriculum targeting low-income youth from 3rd grade to 8th grade in order to prepare the youth to be active, educated participants in their healthcare. Lessons focus on asthma, obesity and overweight, accidental injury, and drug and alcohol use. Curriculum development was based on qualitative and quantitative assessment of the target population. The preliminary findings from the pilot project show an increase in knowledge, improved healthy behaviors, and enthusiasm from participants and facilitators. The development of the pilot project is described, with a suggestion for future development of youth health literacy assessment tools.

A practitioner-based asthma intervention program with African American inner-city school children

INTRODUCTION

Asthma is the most prevalent chronic illness, affecting more than 7 million children younger than 17 years. Asthma has become a leading public health concern because of the dramatic rise in the incidence of this disease during the past 15 years, particularly in minority populations. This study tested a two-part intervention on selected psychosocial and health outcomes of 8- to 13-year-old inner city minority students with asthma.

METHOD

The intervention consisted of participation in an asthma education program (Open Airways) followed by 5 monthly visits with a nurse practitioner. The total sample of 52 children was composed of 28 children in the treatment group who received the intervention and 24 children who served as a control group.

RESULTS

Students in the treatment group scored significantly higher than the control group over time on measures of asthma knowledge, asthma self-efficacy, general self-care practices, and asthma self-care practices. No significant differences were found between the two groups on health outcomes.

DISCUSSION

A school-based intervention program can improve psychosocial outcomes for inner-city minority children with asthma. Recommendations for future research and clinical practice are discussed.

The effects of a school-based intervention on the self-care and health of African-American inner-city children with asthma

Asthma is a chronic illness that affects 5% to 10% or about 5 million children in this country. Morbidity and rising mortality rates are of particular concern in minority children. This study addresses a serious knowledge deficit about the management of asthma in minority children by testing the effect of a school-based asthma education program on psychosocial and health outcomes of 8-13-year-old inner-city minority students. Although the mean scores of the treatment group were higher than the control group on several of the psychosocial measures, these changes were not significant. However, significant differences were found between the groups on health outcomes. Recommendations for future research and clinical practice are discussed.