Chest
Volume 121, Issue 5, May 2002, Pages 1661-1669
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Special Report
Strengthening Asthma Education to Enhance Disease Control

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This article focuses on reducing the barriers to effectively applying what is known about asthma patient education. One barrier to effective asthma control in individuals and populations is failure to recognize the range of influences on patients trying to manage their disease, including actions of family, clinicians, friends and neighbors, work or school mates, and significant people and organizations in the wider social environment. Another deterrent is failing to assist patients in developing their self-regulation skills. Other barriers are the lack of attention to the patients' asthma management goals (as opposed to clinical objectives) and overlooking signs that indicate follow-up education is needed. Five actions taken by health-care professionals could significantly enhance the effectiveness of asthma education: (1) make messages to patients and core skills taught consistent with national asthma guidelines; (2) focus on developing the patient's ability to self-regulate; (3) develop comprehensive plans for treatment and education that assign clinicians to appropriate educative roles; (4) use clinician communication techniques demonstrated to enhance asthma management by patients; and (5) ensure that all providers of education are themselves trained to achieve actions 1 to 4.

Section snippets

The Circles of Influence on Patients Managing Asthma

As asthma is a condition that cannot be prevented or cured, the aim of everyone must be to control its effect on a patient's health status and functioning, to curtail its disruptive impact on family life, and to reduce the health-care and other costs associated with it. We have found that one way to understand the range of influences on effective asthma control is to envisage concentric circles revolving around the patient (Fig 1). Each ring of the concentric circles represents people,

Barriers to Effective Asthma Control

Several factors and practices appear to work against asthma control.

Actions to Make Asthma Education More Effective

Five actions (Table 1) on the part of those involved in asthma education may enhance its effectiveness.

First is to ensure that the objectives, messages, skills, and processes of asthma education are consistent with the national asthma guidelines in use in a given country. Cabana and colleagues79 reviewed 76 studies describing why physicians do not follow guidelines for practice. They concluded that there are 10 types of barriers: (1) lack of awareness, (2) lack of familiarity, or (3) lack of

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