Impact of a Curriculum Intervention on Asthma Knowledge in Adolescents of a Public School in Salvador-Bahia-Brazil
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The purpose of this study is to estimate the impact of a curriculum intervention on asthma
      knowledge in adolescents of a public school in Salvador-Bahia-Brazil.
    

Detailed description: 
      Asthma is one of major causes of morbidity and mortality due to chronic diseases worldwide
      with higher mortality and morbidity in adolescents. Interventions directed to adolescents and
      systematically developed within the school environment has been performed around the world.
      In spite of that, studies such Bruzzese (2004; 2011) have already shown that clinical
      interventions associated with educational activities in group composed of individuals with
      similar lifestyles and characteristics are able to modify the behavior of the individual as
      well as reduce emergency room visits and hospitalizations. Thus, it is necessary to develop
      this study.

      This study is a controlled clinical trial. The intervention will be a curriculum intervention
      on asthma. This intervention will consist of theoretical - practical weekly workshops with a
      targeted content for asthma and involves aspects related to anatomy and physiology of the
      respiratory tract, conceptualization of asthma, prevention, treatment, maintenance and
      retrieval; recognition and actions in periods of exacerbations and use the action plan. These
      workshops are suitable for the course plan of disciplines sciences, biology, chemistry,
      physics, history , geography, portuguese and mathematics . Those are characterized as a
      mandatory curriculum component and they should be developed for all students in elementary
      and secondary education.

      In parallel curriculum intervention, the investigators will identify the frequency of
      individuals with diagnosis/symptoms suggestive of asthma by applying the ISAAC questionnaire
      and verification of Forced Expiratory Volume in one second (FEV1) using the portable
      Vitalograph copd - 6. This assessment will identify students with suspected asthma, symptoms
      suggestive of asthma and asthma diagnosed.

      The curriculum will be organized educational intervention with school staff to be applied to
      the intervention group (it includes all students from 10 to 19 years previously registered.
      The afternoon shift is defined as the intervention group and may participate asthmatic and
      non-asthmatic students). It is noteworthy that, subsequently, the same intervention will be
      performed with the control group (in which students participate in the morning shift and may
      participate in asthmatic and non-asthmatic students). The intervention group will receive a
      complementary intervention where questions directed reinforce attitudes in periods of
      exacerbation and use the action plan, while the control group will receive this same
      intervention after the study.

      The study will be held at the College Presidente Emilio Garrastazu Medici (Currently its name
      is College Estadual do Stiep Carlos Marighella) which is a school unit with medium-sized and
      offers all series of the second segment of the Elementary School, Middle School and
      Professional Education. This school was chosen because of system of evaluation and teaching
      methodology as well defined in its political pedagogical project.

      The investigators will identify the frequency of individuals with diagnosis/symptoms
      suggestive of asthma by applying the ISAAC questionnaire and verification of Forced
      Expiratory Volume in one second (FEV1) will monitor all individuals duly registered and
      allocated in the age group 10-19 years are enrolled in the 5th to 8th grades in this study.

      A despite about data Collection Instrument, will be used: 1. Questionnaires ISAAC -
      International Study of Asthma and Allergies in Childhood; 2. Form to characterize the
      subjects and clinical outcomes and 3. Structured questionnaires for assessing knowledge (two
      different data collection instruments):

        1. Questionnaires ISAAC - International Study of Asthma and Allergies in Childhood:

           In the first phase of the study, standardized questionnaires developed by ISAAC will be
           applied. It aims to evaluate symptoms suggestive of asthma. The first part of the
           questionnaire consists of 8 questions which mainly use 3 questions to estimate the
           prevalence of asthma : 1 - " Did you ever in your life you (or your child ) had wheezing
           (wheezing )? " , 2 - "In the last twelve months you (or your child ) had wheezing (
           wheezing )?" 3 - "Have you ( or your child ) had asthma?".

        2. Form to characterize the subjects and clinical outcomes:

           This form is composed of two parts: the first part consists of demographic and socio
           biological data and the second parts of issues related to clinical outcomes. The
           variables are emergency due to asthma in the past year, emergency due to asthma in past
           30 days, emergency due to asthma past two weeks, prior oral intubation, hospitalization
           due to asthma in the last year, ICU admissions, nocturnal awakenings in the last year,
           nocturnal awakenings in the last 30 days, nighttime awakenings in the last two weeks,
           daytime last year awakenings, daytime awakenings in the last 30 days, daytime awakenings
           in the last two weeks, number of days missed at school in the last year, number of days
           missed at school last month, number of lost subjects (if already deprecated) in the last
           year, use of control medications, spirometric values. This form must be applied before
           and after implementation of the intervention.

        3. Form for assessing knowledge:

      To assess knowledge about asthma and the exacerbation due to this disease, a structured
      questionnaire that contains 20 questions with three possible answers to all questions will be
      used: "Yes", "no" and " I do not know". This questionnaire is organized so that a number of
      questions covering a field but it is not built for the explicit subject in the research.

      The areas are: knowledge of the pathology, triggers, treatment, management of crisis and
      myths/truths so that the researcher can analyze the performance counting the overall score
      and domains.The adjustments represent the knowledge level of the respondent. Up to 25 % of
      hits - Poor knowledge; 26 - 50% correct - satisfactory knowledge; 51-75 % accuracy - Good
      knowledge; 76-100 % correct - excellent knowledge.

      Knowledge about learning about relief treatment and maintenance will be carried out through a
      questionnaire consists of 4 situations that mimic reality. It trys to observe the therapeutic
      knowledge of the individual in situations of imminent asthma attack , with the following
      options answer: "never", "rarely", "sometimes" , "often" ,"always".

      The investigators will collect data and analyzed in the period from October 2011 to December
      2014. Tools of data collection described above and after signing the Informed Consent and the
      Coordinator of School and after approval of the research by the Ethics Committee -
      Universidade Federal da Bahia. This protocol was submitted and approved.

      The investigators will use the Statistical Programme Statistic Program for Social Sciences
      (SPSS) version 21.0 to process data. We will analyse data by descriptive statistics
      (proportions and measures of central tendency), Relative risk (RR) , absolute risk (AR) ,
      odds ratios (OR) and logistic regression analysis to identify the measures of association
      will be used effect of systematic educational interventions independent of confounding
      variables. In all analyzes will be considered the significance level of 5 % .

      The ethical aspects shall be based on Resolution 196/96 governing research involving human
      subjects, the resolution 466/2012 and the Code of Ethics for Professional Nursing. The
      research will respect the basic principles of bioethics: autonomy, non - maleficence,
      beneficence, and justice, and should be appropriate to scientific principles, rely on free
      and informed consent of the research subject and / or his legal representative, establish
      procedures to ensure confidentiality and privacy of the people involved indirectly. The
      Program will receive the return of the results obtained through research.
    

Intervention name(s): Knowledge about Asthma and Respiratory Education (KARE)
Intervention type(s): Behavioral
Intervention description(s): KARE - Knowledge about Asthma and Respiratory Education is an educational curriculum intervention organized with school staff to be applied to the intervention group. This intervention will consist of theoretical - practical weekly workshops with a targeted content for asthma and involves aspects related to anatomy and physiology of the respiratory tract, conceptualization of asthma, prevention, treatment, maintenance and retrieval; recognition and actions in periods of exacerbations and use the action plan. These workshops are suitable for the course plan of disciplines sciences, biology, chemistry, physics, history, geography, portuguese and mathematics. Those are characterized as a mandatory curriculum component and they should be developed for all students.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Asthma; Knowledge; School-Based Service; Adolescents