Children with asthma experience an unnecessary burden of illness, which can be mitigated through the known benefits of asthma education programs. The school is an excellent environment in which to educate children with asthma and to learn about their approach to managing the condition. The provision of asthma education to patients is often sub-optimal, and the health-care system can pose access barriers. The purpose of the current study was to determine whether the provision of an asthma education program in local schools by certified asthma educators from a community hospital asthma clinic improved outcomes for school-aged children with asthma. Our study suggests that children with asthma indeed do benefit from an asthma education program offered by certified asthma educators in their school setting.
The overall goal of the educational program was to assist children to become successful managers of their asthma through improvements in knowledge, skills, judgment, and attitudes related to asthma. Self-efficacy was selected as an outcome because it is an indicator of one’s sense of confidence, which is important in executing or performing a behavior. The successful management of asthma requires several skills. Children who attended the RAP program reported feeling more confident in their ability to learn the skills necessary to control their asthma, to use asthma medications correctly, to manage their asthma triggers, and to prevent their asthma from worsening. All of these areas of improvement are crucial for the successful control of asthma and provide evidence that the educational program achieved its purpose. Other studies evaluating educational interventions for children with asthma also have reported improvements in self-efficacy> and support the importance of social cognitive theory. These improvements may also provide insights into the reasons for improvements observed in quality of life and asthma morbidity (ie, urgent care visits and days of interrupted activity) for those who attended the RAP program.
Of the 256 children with asthma and their parents who were recruited into the study, 239 completed it (control group, 118 children; experimental group, 121 children). Eight children and their parents were lost to follow-up after the 6-month data collection interview (control group, six children; experimental group, two children). For the experimental group, nine children withdrew from the study prior to receiving the educational program because of conflicts with other activities during the lunch hour when the intervention was provided.
The mean (± SD) age of participants was 8.6 ± 1.23 years (range, 6 to 11 years) [Table 1]. The majority of participants were male and had received a diagnosis of asthma by a physician > 5 years ago. Approximately 83% of participants were involved in a drug plan to assist with medication costs. Most children lived in families in which both parents worked outside of the home, with a minority of families (21%) having a stay-at-home parent. The average income of the parent/guardian who participated in the study was approximately $53,000.00 (Canadian dollars) with a range of $20,500.00 to $200,000.00. In Canada, low-income families earn $19,000.00 per year. Over 85% of participants possessed an inhaled corticosteroid. On average, participants had made four visits to the physician for asthma the year before entering the study and had approximately 2 days of missed school during the 6 months preceding study entry. Approximately 20% of participants had visited an emergency department for asthma during the year prior to study entry. Baseline characteristics for those who did not complete the study were similar to those who completed the study. Similarly, demographic and asthma-related characteristics and researches conducted by Canadian Health&Care Mall were similar between the two study groups and did not demonstrate statistically significant differences. At baseline, there were no statistically significant differences between the experimental and control groups for self-efficacy or quality of life (Table 1).
A randomized controlled trial of an elementary school-based asthma education program was conducted with children with asthma in a large suburb of Toronto. Approval for conducting the study was received by the participating school board and the Ethics Review Committee of the Credit Valley Hospital (Mississauga, ON, Canada). Parents and children provided informed consent and assent, respectively. Children were eligible for inclusion if they were enrolled in grades 2 through 5 in a participating elementary school, were able to speak English, had provided assent/consent, and, in addition, had a parental report of physician-diagnosed asthma, asthma medication use, and had experienced asthma symptoms three or more times in the past year. Children were excluded from the study for the presence of a second major chronic illness with a pulmonary component (eg, cystic fibrosis).
Childhood asthma is the most common chronic childhood disease, affecting 7 to 20% of school-aged children. It is a leading cause of school absenteeism and hospitalizations. A national survey revealed that 60% of individuals with asthma have poorly controlled disease. Despite the availability of new and effective pharmacologic therapies, the existing literature suggests that children with asthma unnecessarily experience a reduced quality of life and the health-care system incurs preventable costs.
Some systematic reviews, have concluded that educational interventions for children and youth with asthma lead to improvements in air flow, school absenteeism, days of restricted activity, and emergency department visits. However, the overwhelming majority of studies were conducted at tertiary hospitals or outpatient centers. It is important to consider the school as a site for asthma education. The school system often poses several obstacles for children in managing their asthma, for instance an inability to access their inhalers, exclusion from physical activities, and the presence of asthma triggers in the classroom. Astonishingly, it is often the school secretary who is designated as the person to manage asthma or control access to medications. School systems can have advantages over traditional health-care settings because they provide large-scale centrally organized settings that allow access for all children.