Evaluation of a school-based asthma education program for inner-city children,☆☆,,★★

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Abstract

Background: We have previously reported a high prevalence of current asthma-related symptoms affecting predominantly Hispanic, socioeconomically disadvantaged schoolchildren in Southeast San Diego. Objective: We sought to assess the impact of a school-based education program on asthma outcomes. Methods: In cooperation with the San Diego Unified Schools, we developed and implemented a school-based asthma education program. Based on the National Heart, Lung, and Blood Institute consensus guidelines for asthma, the five-session bilingual, interactive curriculum was conducted in 20-minute segments. Asthma knowledge was tested before and after the education program, and asthma severity was prospectively assessed at monthly intervals. Outcome parameters were compared in educated and control (noneducated) fourth grade students with asthma by using nonparametric techniques. Results: After asthma education, students demonstrated improvement with increases in mean scores for: asthma knowledge quiz from 9.9 (SEM  = 0.44, n = 34) to 13.7 (SEM = 0.30); peak flowmeter technique from 3.9 (SEM = 0.33, n = 32) to 6.4 (SEM = 0.29); and inhaler technique from 2.3 (SEM = 0.26, n = 32) to 4.3 (SEM = 0.26). All changes were highly significant (p ≤ 0.00001 as determined by Wilcoxon matched-pairs signed-rank test). Mean score comparisons for asthmatic control students given paired examinations after a time interval matched with the educated students, did not reach statistical significance: quiz score of 11.3 (SEM = 0.80, n = 11) versus 10.9 (SEM = 0.68), peak flowmeter technique score of 2.6 (SEM = 0.50, n = 18) versus 3.1 (SEM = 0.37) , and inhaler technique score of 2.5 (SEM = 0.37, n = 18) versus 2.2 (SEM = 0.31). Prospective monthly data were collected on 27 educated and 15 control asthmatic subjects. Severity of asthma was not significantly different between groups at entry to the study. Symptom questionnaires, validated for functional asthma severity, revealed a significant reduction in mean symptom scores at 180 days for the educated (2.87, SEM = 0.447) versus the control (4.36, SEM = 0.573) groups (p  = 0.0188 as determined by the Mann-Whitney U test). Conclusion: Child-centered asthma education can be successfully conducted in the school setting, resulting in increased asthma knowledge, improved skills for peak flowmeter and inhaler use, and a reduction in the severity of asthma symptoms.

Section snippets

Study population

Approval for conducting the study was obtained from the San Diego City Schools and the Institutional Review Board of Scripps Clinic and Research Foundation. The study population consisted of fourth grade student volunteers enrolled at four schools in the San Diego Unified School District. The demographics of the four schools have been previously presented.1 Students with current asthma-related symptoms were identified through a parent survey questionnaire, follow-up student questionnaire,

Asthma quiz, peak flowmeter technique, and inhaler technique

Improvement was demonstrated in asthma knowledge in 34 asthmatic students in the educated group. Results were analyzed by comparing baseline with posteducation scores. Mean scores for the asthma quiz improved from 9.9 (SEM = 0.44) to 13.7 (SEM = 0.30). The 32 students in this group available for pre- and posttesting also demonstrated improvement in peak flowmeter and inhaler technique. Peak flowmeter scores improved from 3.9 (SEM = 0.33) to 6.4 (SEM = 0.29), and inhaler technique scores

Discussion

Self-management education programs have evolved effective methods to inform subjects as to the nature of their disease and appropriate responses for control of their illness. Those programs that incorporate tools such as goal-setting and social reinforcement have proven more successful in promoting learning and behavioral change as opposed to those that involve passive learning. The potential utility of an educational/behavior modification approach to asthma stems from the improved ability of

Acknowledgements

We thank Judy Beck, RN, for her invaluable assistance in the initiation of this study at the San Diego City Schools. The cooperation of the administrative, nursing, and teaching staff at the school sites is also gratefully acknowledged.

References (12)

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From the Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla.

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Supported in part by grant AI 32834 from the National Institutes of Health and Scripps Clinic Department of Medicine grant 121203804.

Reprint requests: Sandra Christiansen, MD, Scripps Clinic and Research Foundation, 10666 N. Torrey Pines Rd., La Jolla, CA 92037.

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