Intervention for Hispanic Children With Asthma
Condition: Asthma; Lung Diseases
MeSH terms: Asthma; Lung Diseases
Study type: Interventional

Summary: 
      To design, implement, and evaluate an intervention program for Hispanic children with asthma
      which included both a physician education and a patient/family education component.
    

Detailed description: 
      BACKGROUND:

      Although asthma affects 6-10 percent of children aged 6-16 years, the prevalence of asthma in
      Hispanic groups and the degree of resulting morbidity were unknown in 1990. The study sought
      to answer the following questions: 1) Would a physician education intervention result in
      improved medical management for Hispanic children with asthma who were cared for within the
      context of an outpatient clinic? 2) Would a focused educational intervention for Hispanic
      children with asthma and their families result in decreased morbidity and improved quality of
      life? If effective, the physician education and patient education programs could serve as
      models for the implementation of similar programs in outpatient clinic settings which serve
      Hispanic children with asthma.

      The study was part of a demonstration and education initiative "Interventions for Control of
      Asthma Among Black and Hispanic Children" which was released by the NHLBI in June 1989.

      DESIGN NARRATIVE:

      Prior to enrollment of patients, all physicians participated in an intervention which
      included the following elements: a brief seminar about medical management for children with
      asthma, introduction of protocols in low chart format (algorithms), use of a standardized
      progress note from for children with asthma, a series of computer-based simulations and
      individualized feedback to physicians. The effectiveness of the physician education component
      in changing physician behavior was measured by pre- /post-test, chart audit, and performance
      on computer-based simulations.

      One hundred sixty (160) Hispanic children with asthma, aged 6-15 years who were cared for in
      a pediatric residents' continuity clinic were enrolled for study. A research associate
      interviewed parents and children separately using standardized questionnaires to obtain
      information about 1) health beliefs, 2) reported health behavior, 3) knowledge and attitudes
      about asthma, 4) functional morbidity, 5) acculturation, and 6) socio-demographic factors. A
      research nurse performed spirometry on each subject. Additional information was obtained by
      review of medical records and school attendance records. Patients were then randomized into
      treatment and control groups. Treatment group patients and their families participated in the
      patient education intervention. The intervention consisted of a series of four videotapes and
      written materials which focused on major aspects of self-management for children with asthma.
      Patients and families received the four modules at one month intervals. Selected modules were
      reviewed with the research nurse at appointed visits approximately six, 9, and 12 months
      following enrollment. Follow-up data were obtained by interview, medical record review, and
      spirometry at six, 12, 18, and 24 months following enrollment.

      Intervention and control group children were compared for morbidity (the number of emergency
      room visits, hospitalizations, school days missed) and quality of life (impact on family and
      functional status), after controlling for confounding variables. Secondary data analysis
      examined the effect of the intervention on knowledge, reported health behaviors, and
      post-intervention spirometry.
    

Intervention name(s): Asthma self-management education
Intervention type(s): Behavioral
Intervention description(s): Treatment group children and their families participated in the patient education program which consisted of four separate one-hour sessions. The topics were: symptoms of asthma, causes of asthma ("triggers"), medications, and peak flow. A bilingual nurse educator working one-on-one with the child and family members delivered these four sessions. The four sessions were delivered over a six week period. Culturally sensitive educational materials include both print (flip charts, take-home brochures) and videotape materials. The videotapes feature children from the clinic and highlight how they successfully manage their asthma. All materials are available in both English and Spanish.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment