Asthma control in London secondary school children

ObjectiveTo explore the barriers and facilitators to inhaled asthma treatment in adolescents with asthma.DesignQualitative analysis of posts about inhaler treatment in adolescents from an online forum for people with asthma. Analysis informed by the Perceptions and Practicalities Approach.ParticipantsFifty-four forum participants (39 adolescents ≥16 years, 5 parents of adolescents, 10 adults with asthma) identified using search terms ‘teenager inhaler’ and ‘adolescent inhaler’.SettingPosts from adolescents, parents and adults with asthma taking part in the Asthma UK online forum between 2006 and 2016, UK.ResultsPractical barriers reducing the ability to adhere included forgetfulness and poor routines, inadequate inhaler technique, organisational difficulties (such as repeat prescriptions), and families not understanding or accepting their child had asthma. Prompting and monitoring inhaler treatment by parents were described as helpful, with adolescents benefiting from self-monitoring, for example, by using charts logging adherence. Perceptions reducing the motivation to adhere included asthma representation as episodic rather than chronic condition with intermittent need of inhaler treatment. Adolescents and adults with asthma (but not parents) described concerns related to attributed side effects (eg, weight gain) and social stigma, resulting in ‘embarrassment of taking inhalers’. Facilitators to adherence included actively seeking general practitioners’/consultants’ adjustments if problems arose and learning to deal with the side effects and stigma. Parents were instrumental in creating a sense of responsibility for adherence.ConclusionsThis online forum reveals a rich and novel insight into adherence to asthma inhalers by adolescents. Interventions that prompt and monitor preventer inhaler use would be welcomed and hold potential. In clinical consultations, exploring parents’ beliefs about asthma diagnosis and their role in dealing with barriers to treatment might be beneficial. The social stigma of asthma and its role in adherence were prominent and continue to be underestimated, warranting further research and action to improve public awareness of asthma.

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“…Nevertheless issues with taking inhalers described in this study do triangulate with the ones emerging from UK school teenagers (). 23 …”

Section: Discussionmentioning

confidence: 99%

What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum

et al. 2017

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“…For the majority of asthma patients, medications have the potential to control symptoms well [1]. Yet, there is evidence in the UK that almost half (49.6%) of young people (between 12 and 18 years of age) has suboptimal asthma control when assessed by the Asthma Control Test (ACT) [2]. Poor control frequently leads to unscheduled medical care with 30% of young people reporting an unplanned visit to a general practitioner (GP) in the past month [2].…”

Section: Introductionmentioning

confidence: 99%

“…Yet, there is evidence in the UK that almost half (49.6%) of young people (between 12 and 18 years of age) has suboptimal asthma control when assessed by the Asthma Control Test (ACT) [2]. Poor control frequently leads to unscheduled medical care with 30% of young people reporting an unplanned visit to a general practitioner (GP) in the past month [2]. UK also has a higher rate of asthma-related deaths compared to other European countries [3,4].…”

Section: Introductionmentioning

confidence: 99%

Developing a theory-based multimedia intervention for schools to improve young people’s asthma: my asthma in school (MAIS)

Mosler

Harris

Grigg

et al. 2020

Pilot Feasibility Stud

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Background: Asthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents. Methods: The intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COMB (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13. Results: The complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma.

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“…In particular, the reported use of a theoretical framework in the study appeared to distinguish between studies that were more effective in reducing levels of school absences compared with those that were not. While there is no universal consensus as to the importance of school absences as an indicator of asthma control,23 demonstrating improvement on this indicator may be important in gaining access to school sites and the cooperation of school staff. This result does not indicate that use of theory is causal in reducing school absences.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis

Kneale¹,

Harris

McDonald

et al. 2019

Thorax

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IntroductionThe evidence that teaching self-management techniques to children and young people with asthma in schools is effective has not, to date, been the subject of systematic review.MethodsWe conducted a systematic review of intervention studies. Studies were eligible if they employed a randomised parallel-group design and were published in English from 1995 onwards. Participants included children with asthma aged 5–18 years who participated within their own school environment. Searches were conducted on the Cochrane Airways Group Specialised Register. Quantitative data were combined using random-effects meta-analyses.ResultsThirty-three outcome evaluation studies were included. School-based interventions were effective in reducing the frequency of emergency department visits (OR 0.70, 95% CI 0.53 to 0.92; studies=13), and moderately effective in reducing levels of hospitalisations (standardised mean differences [SMD] −0.19, 95% CI −0.35 to −0.04; studies=6). A meta-analysis of three studies suggest that the intervention approach could reduce the number of days of restricted activity (SMD −0.30, 95% CI −0.41 to −0.18; studies=3). However, there was uncertainty as to whether school-based self-management interventions impacted on reducing absences from school.ConclusionsSelf-management interventions for children with asthma delivered in schools reduce the number of acute episodes of healthcare usage. We conclude that the school environment is an important space for delivering interventions to improve children’s health.

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Asthma control in London secondary school children

Cited by 15 publications

References 17 publications

What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum

What do adolescents with asthma really think about adherence to inhalers? Insights from a qualitative analysis of a UK online forum

Developing a theory-based multimedia intervention for schools to improve young people’s asthma: my asthma in school (MAIS)

Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis

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