An empowerment-centered, church-based asthma education program for African American adults.

Asthma, a chronic inflammatory condition of the airways, is a major health problem in the United States, affecting about 12 million people (Bailey et al., 1992; British Thoracic Society, 1990; Huss et al., 1992). People with asthma experience on average more than 100 days of restricted activity annually (Bailey et al., 1992). Mortality and morbidity due to asthma are increasing, particularly among African Americans (Buist & Vollmer, 1990; Wilson, 1993). The costs for treating asthma in African Americans are exceptionally high because members of this population tend to use the emergency department as a primary source of care (Baker, Stevens, & Brooks, 1994; Kellerman, 1994). It is important that African Americans learn, through asthma self-management programs, what they need to manage their asthma and how to meet these needs through the health care system and increase their access to health services. As African Americans with asthma increase their access to and use of primary care and their use of inhaled corticosteroids as appropriate, they will better manage their asthma, thus maintaining their activity levels and reducing asthma-related mortality and morbidity and emergency department use (Bauman et al., 1989; Clark & Starr-Schneidkraut, 1994; Sly, Cahill, Willet, & Burton, 1994). ASTHMA SELF-MANAGEMENT Two central components of most asthma education programs are asthma attack prevention and attack management (Clark & Starr-Schneidkraut, 1994). Asthma education and skills training in self-management help individuals draw from a base of asthma knowledge and make appropriate decisions and take corrective actions (Bauman et al., 1989; Clark & Starr-Schneidkraut, 1994). The knowledge gained by participants in educational programs, such as accurate use of peak flow meters and asthma inhalers, may positively affect their perceptions of asthma; these perceptions have been found to play a major role in how well patients adhere to medical treatment regimens (Acker, 1992; Taytard, 1992). As individuals become more proficient at managing their asthma and are able to function better in their daily lives, their asthma-related quality of life should improve (Juniper, Guyatt, Ferrie, & Griffith, 1993; Rowe & Oxman, 1993). Researchers agree that for behavioral changes to be long lasting, they must become sufficiently integrated into aspects of individuals' daily lives (Bauman et al., 1989; Bolton, Tilley, Kuder, Reeves, & Schultz, 1991). Empowerment Principles To help individuals integrate asthma management into their daily lives, asthma self-management courses must teach principles of empowerment. Empowerment refers to the development of the personal resources (social, psychological, intellectual, and spiritual) individuals need to give them control and mastery over their lives (Feste, 1992; Kalyanpur & Rao, 1991). Developing these personal resources is especially critical for African Americans with asthma, a disease in which much of the burden of day-to-day management and recognition of symptoms rests with the individual. In addition, African Americans have traditionally held a disempowered political, economic, and social position in U.S. society and have thus been prevented from exercising control and mastery over their environments (McKinney, Harel, & Williams, 1990; Thomas & Quinn, 1991). Empowerment-centered asthma education can help African Americans with asthma better manage this chronic condition. Church Setting Asthma education programs can be offered in the local church, a context central to many African Americans. Taylor and Chatters (1986) described the African American church as functioning as an "omnipresent and important institution" (p. 637) for African Americans of all ages. Historically, churches have provided for the educational, nutritional, psychological, and employment needs of African Americans and been focal points for community activities (Taylor, Thornton, & Chatters, 1987; Walls & Zarit, 1991). …