Lay educators in asthma self management: Reflections on their training and experiences

doi:10.1016/j.pec.2007.05.009

Patient Education and Counseling

Volume 68, Issue 2, October 2007, Pages 131-138

https://doi.org/10.1016/j.pec.2007.05.009 Get rights and content

Abstract

Objective

To capture the experiences and feelings of lay educators in an asthma self-management programme to aid understanding of optimal methods of recruitment, training and retention, and to enhance their value within the programme.

Methods

A multi site randomised controlled equivalence trial of asthma educators and primary care practice based nurses during which the educators were asked to keep a diary of their experience. A qualitative thematic analysis of these diaries was undertaken.

Results

Eight lay educators supplied diaries. From these diaries emerged personal reasons for involvement in the programme, constructive comments on the training programme, a need for preparation for the realities of clinical practice and significant ongoing support and training.

Conclusion

Lay educators are a potential resource for giving self-management education to patients with long-term conditions such as asthma. However, there are some considerations that need to be taken into account regarding contracts, retention and continual support.

Practice implications

Lay educators need a flexible but comprehensive training programme, contracts, on site mentoring and support. They seem most contented when welcomed by health professionals and treated as part of the team.

Introduction

There are 5.2 million people diagnosed with asthma in the UK [1]. The British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS/SIGN) guidelines on asthma management recommend that those with asthma should receive self-management education [2]. In the UK much routine care of those with asthma is offered by primary care practice based nurses [3] A systematic review of 36 randomised controlled trials of self management education compared with usual care has shown benefit in terms of reduced rate of hospitalisation, need for unscheduled health care, night time waking and time off work or school [4]. Receiving a written personal asthma action plan has been shown to be an important part of such education [4]. Other reviews have determined the optimal content of action plans [5]. Despite this, one study [6] revealed that only 3% of patients had been given an asthma plan and another found 20% of patients had been provided with a plan but that 62% confirmed they would be willing to follow such an action plan [7]. Why such advice is not offered to patients is unclear, but if health professionals are pressurised by time and other constraints there is a need to evaluate alternative methods of delivering this aspect of respiratory care. This led to the hypothesis that a well-trained lay educator could give self-management education as effectively as a nurse.

The results of the overall study, a randomised controlled study involving 567 patients from two centres (London and Manchester), will be reported elsewhere; this report is concerned with the lay educators’ reflection on their recruitment, training and work with those with asthma.

Section snippets

Methods

The intervention was a disease-specific asthma self-management education programme delivered either by a practice nurse or by a lay person. A total of 15 lay trainers were recruited by advertisement from London and Manchester, which were also the areas in which they were to work. Criteria for selection were that the trainer or a close relative had to have asthma. No minimum educational qualifications were stipulated. After recruitment, the lay persons underwent a two-day residential training

Results

The details of the lay educators and their previous educational attainments are shown in Table 1 and Fig. 1. Of the 15 lay educators who were recruited, nine dropped out over the subsequent 22 months for health, personal or occupational reasons. Eight lay educators produced diaries, including one lay educator who subsequently withdrew before seeing patients. The major themes identified in the diaries concerned the lay persons’ reasons for taking part in the study, their initial feelings on

Discussion

Our lay educators’ reflections have highlighted some important considerations for those seeking to undertake comparable work. Lay educators need support and reassurance, especially at the beginning, on recruitment, throughout the training and during the initial phase of first seeing patients. Educators did undertake at least one consultation with a trainer present (though this was mainly for quality assurance purposes). For future programmes, it is suggested that lay educators have the option

Acknowledgements

The authors gratefully acknowledge the support of the BUPA Foundation and the hard work of the lay educators and the co-operation of the practices and patients in this study.

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Lay educators in asthma self management: Reflections on their training and experiences☆

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Primary Care Resp J

British guideline on the management of asthma

Thorax

Community asthma clinics: 1993 Survey of primary care by the National Asthma Task Force

Qual Health Care