Small-group,interactive education and the effect on asthma control by children and their families

Background

Effective approaches to education about asthma need to be identified. We evaluated the impact on asthma control by children and their caregivers of an intervention involving small-group, interactive education about asthma.

Methods

We randomly assigned children who visited an emergency department for an exacerbation of asthma (n = 398) to either of 2 groups. Children assigned to the control group followed the usual care recommended by their primary care physician. Those assigned to the intervention group participated in a small-group, interactive program of education about asthma. We examined changes in the number of visits to the emergency department during the year after the intervention.

Results

During the year after enrolment, children in the intervention group made significantly fewer visits to the emergency department (0.45 visits per child) compared with those in the control group (0.75 visits per child) (p = 0.004). The likelihood of a child in the intervention group requiring emergency care was reduced by 38% (relative risk RR] 0.62, 95% confidence interval CI 0.48–0.81, p = 0.004). Fewer courses of oral corticosteroids (0.63 per child) were required by children in the intervention group than by those in the control group (0.85 per child) (p = 0.006). We observed significant improvements in the symptom domain of the questionnaire on pediatric asthma quality-of-life (p = 0.03) and the activity domain of the questionnaire on caregivers’ quality of life (p = 0.05). Parents of children in the intervention group missed less work because of their child’s asthma after participating in the educational program (p = 0.04). No impact on hospital admissions was observed.

Interpretation

Education about asthma, especially in a small-group, interactive format, improved clinically important outcomes and overall care of children with asthma.Management of asthma often focuses on “crisis intervention,” meaning that the disease is addressed only when a problem occurs. Shifting emphasis to a preventive health model, which includes guided self-management, has been shown to reduce costs related to hospital admissions and visits to emergency departments.¹ Education about asthma is an integral part of the recommendations of most guidelines for the management of asthma.^2–4There is no consensus on the best model for education about asthma. A review of publications from 1991 through 2004 showed that only half of the studies identified were randomized controlled trials and that many studies used patients as their own historic controls.⁴ Given that a regression to the mean is commonly observed in the data of such studies, with improvements in asthma over time, the use of historic controls is not an acceptable means of defining the impact of education. The studies reviewed also varied greatly in the demographic characteristics of the participants, the professional qualifications of the educators used, the nature of the interventions, the outcomes measured, the time frames for measurement and the inclusion of medical care and other services. These variations make it difficult to compare results and make firm recommendations.^5–15Programs of education about asthma are typically directed toward the learner and conducted using either a one-on-one, large-group or small-group format. The intervention may consist of self-directed educational material, lectures (i.e., a teacher-focused format) or group interaction (i.e., a learner-focused format). Effective change in behaviour occurs when learners actively interact with the content to be learned, with the teacher and with each other.¹⁶ Small groups of fewer than 10 members allow for an ideal level of interaction. Westberg and Jason¹⁷ cite several compelling reasons for using small groups to promote learning. Learners are more likely to take ownership of their education and may be more engaged with the material. They can learn from each other in a supportive, nonjudgmental environment. They can both give and receive peer-oriented feedback. They can practise skills that can be applied later in real-life situations. Learners retain and transfer knowledge more effectively when they are able to practise what they have learned.¹⁸ For children with asthma and their families, such a model would help facilitate memory retention and a higher comfort level with future decisions related to management of asthma.We conducted a randomized controlled trial to evaluate the impact on asthma control of an intervention involving small-group, interactive education of children with asthma and their caregivers.