Enhancing Asthma Self‐Management in Rural School‐Aged Children: A Randomized Controlled Trial

Abstract

Purpose To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas. Methods Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2–5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group. Findings Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups. Conclusions Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes.

Efficacy of asthma education program on asthma control in children with uncontrolled asthma

“…Asthma control program in Brazil which included training of health professionals and educational interventions for the patients were found to reduce the number of asthma related hospital admissions 20 . Edcuation provided in school asthma class or in asthma day camp also yielded significant reductions in the emergency department and office visits 19 . We found that hospitalizations, emergency room admissions and unscheduled hospital visits were not different between groups but missed school days were significantly lower in education group.…”

“…Most of the studies report reductions in emergency department visits, hospitalizations and overall improvement of asthma control 18,19 . Studies evaluating the effects of education report benefit of education when they evaluate the outcomes on 6th months and 12th months 14,16,[18][19] . We evaluated our outcome measurements 1 and 3 months after intervention.…”

Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents

“…These include asthma education delivered via in-school asthma classes or asthma day camps [68]. Interventions focusing on self-management behaviors beyond simple medication compliance have the most potential for improving asthma outcomes in rural children [69].…”

Medication adherence in pediatric asthma: A systematic review of the literature

“…School‐based accommodations, such as improving access to medications at school and medication administration by school health personnel, can reduce barriers to adherence . A school‐based asthma self‐management program was effective in improving medication adherence compared to an attention control or summer camp self‐management program among rural elementary school children . Home‐based services can increase medication adherence in children with asthma as well .…”

“…21 A school-based asthma self-management program was effective in improving medication adherence compared to an attention control or summer camp self-management program among rural elementary school children. 76 Home-based services can increase medication adherence in children with asthma as well. 9,28,74 For example, delivering in-home Multisystemic Therapy adapted for health care for adolescents and their families is associated with improved adherence.…”