Removing barriers to effective self-management of asthma

doi:10.1016/0738-3991(89)90034-7

Patient Education and Counseling

Volume 14, Issue 3, December 1989, Pages 217-226

https://doi.org/10.1016/0738-3991(89)90034-7 Get rights and content

Abstract

The effectiveness of an asthma self-management program was investigated in a community sample of adults with chronic asthma. The program emphasis was in reducing possible barriers to effective self management. These barriers included lack of asthma knowledge and awareness, poor perceptions of preventive behaviors, negative moods and beliefs, and poor personal sense of control. The extent and stability of change shown by the immediate and long-term follow-ups was impressive for both knowledge of asthma and asthma self management and monitoring behaviors. Implications of these changes are discussed in terms of quality of life and reduced asthma morbidity and mortality. Further research should employ a no-treatment control group which is matched as closely as possible to the intervention group in order to investigate the influence of time.

References (20)

MC Hindi-Alexander
Asthma education programs: their role in asthma morbidity and mortality
J Allergy Clin Immunol
(1987)
M Hindi-Alexander et al.
Evaluation of a family asthma program
J Allergy Clin Immunol
(1984)
R Goldstein et al.
Self-management in childhood asthma
J Allergy Clin Immunol
(1983)
National Health and Medical Research Council
Asthma in Australia: Strategies for Reducing Morbidity and Mortality
(1988)
EA Hills et al.
Death from asthma in two regions of England
Br Med J
(1982)
DC Sutherland et al.
Death from asthma in Auckland: circumstances and validation of causes
NZ Med J
(1984)
CE Lewis et al.
A randomised trial of asthma care training for kids
Pediatrics
(1984)
NA Smith et al.
Effects of intervention on medication compliance in children with asthma
Med J Aust
(1986)
WC Bailey et al.
Promoting self-management in adults with asthma: an overview of the JAB Program
Health Educ Q
(1987)
SR Wilson-Pessano et al.
An evaluation of approaches to asthma self-management for adults: The AIR/Kaiser Permanente study
Health Educ Q
(1987)

There are more references available in the full text version of this article.

Cited by (25)

Effect of educational programs on asthma control and qualitiy of life in adult asthma patients
2005, Patient Education and Counseling
This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent asthma we tested the benefit of individual verbal instructions (IVI), written information (“asthma booklet”, B), and integrated asthma classes (“asthma school”, AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.
Self-management approaches for people with chronic conditions: A review
2002, Patient Education and Counseling
The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.
Patient compliance with peak flow monitoring in chronic obstructive pulmonary disease
1998, American Journal of the Medical Sciences
Background: The factors affecting patient compliance with peak flow monitoring in advanced chronic obstructive pulmonary disease (COPD) were examined using a prospective, blinded study.
Methods: Twenty-eight male veterans were instructed in the use of an electronic, handheld peak flow meter and the modified Medical Research Council dyspnea scale. They then entered a 6-month monitoring phase in which they recorded a dyspnea score once daily and peak expiratory flow rates twice daily, before and after bronchodilator use. The meter displays were disabled so that the patients were blinded to their values. Medical care was provided in the customary manner. Compliance was defined as the ratio of recorded values to all values specified by the protocol, exclusive of those missing due to circumstances beyond the patient's control.
Results: Of 40 patients who met the entry criteria for this study, 8 refused to participate and 4 could not master the technique. The remaining 28 patients were enrolled. Overall, 25 (63% of those eligible) adhered to the protocol until its conclusion or until they became unable to comply because of medical or social problems. Compliance was 89.8::!: 15.0%. Of those followed for longer than 150 days, linear regression showed that only one patient had a decline in compliance over time (r = 0.84, P = 0.04). Compliance was lower in the afternoons (P 0.001) and on days with higher dyspnea scores (P 0.001). No other clinical factors had an effect on patient measurements. Conclusions: A substantial proportion of patients with advanced COPD can be trained in the technique of peak flow monitoring. Compliance is high if patients are enrolled in a longterm, structured program of supervision and periodic retraining.[Am J Med Sci 1998;315(5):296-301.]
A self-management program for adult asthma. Part I: Development and evaluation
1995, The Journal of Allergy and Clinical Immunology
Background: We developed and evaluated a self-management program for adult asthma. In developing the program, we considered questions of format and behavior control. The format we selected included components known to be effective in educational settings. We regulated asthma management behavior through the introduction of environmental cues. Methods: Seventy-six subjects, whose asthma was generally under medical control, were assigned randomly to either a treatment group or a waiting-list control group. Those in the treatment group were exposed to a 7-week program that incorporated proven features of providing effective training and establishing behavioral control. Subsequently, subjects in the control group received the treatment. Short-term evaluation of the treatment was made after the subjects in the experimental group were trained but before the control subjects were trained. Long-term evaluation was conducted after both groups of subjects were trained. Results: Over the short term, self-management training led to fewer asthma symptoms and physician visits and improvement in asthma management skills and cognitive abilities. Over the long term, self-management training was related to lower asthma attack frequency, reduced medication use, improvement in cognitive measures, and increased use of self-management skills. Conclusions: The program improved asthma management in patients whose conditions were already under good medical control. The effects of the program were apparent a year after the conclusion of self-management training. (J A LLERGY CLIN I MMUNOL 1995;95:529-40.)
Asthma prevention
1992, Chest
An asthma education perspective-Is hospital based patient education sufficient?
1991, Patient Education and Counseling

View all citing articles on Scopus

View full text

Original articleRemoving barriers to effective self-management of asthma

Abstract

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Asthma in Australia: Strategies for Reducing Morbidity and Mortality

Death from asthma in two regions of England

Br Med J

Death from asthma in Auckland: circumstances and validation of causes

NZ Med J

A randomised trial of asthma care training for kids

Pediatrics

Effects of intervention on medication compliance in children with asthma

Med J Aust

Promoting self-management in adults with asthma: an overview of the JAB Program

Health Educ Q

An evaluation of approaches to asthma self-management for adults: The AIR/Kaiser Permanente study

Health Educ Q

Original article
Removing barriers to effective self-management of asthma