Parents

Philadelphia Community Asthma Prevention Program

Article Citation(s):
Bryant-Stephens T, Li Y. Community asthma education program for parents of urban asthmatic children. J Natl Med Assoc 2004;96 (7):955–60.

Intervention Setting:
Inner-city community settings that include day-care centers, schools, community centers, and churches in West Philadelphia, Pennsylvania

Target Population:
Self-referred parents of African-American asthmatic children

Program Description:
Families learned about the asthma classes from flyers distributed in libraries, laundromats, health care provider offices, and the emergency department of the Children’s Hospital of Philadelphia. Parents and asthmatic children attended separate classes for a 5-week session on asthma that were generally conducted at community sites in the early evening. Trained parent educators and teen educators taught the asthma classes using the You Can Control Asthma curriculum developed by Georgetown University. In these five, 1-to-2 hour sessions, the following topics were discussed:

• pathophysiology of asthma,
• environmental triggers and avoidance techniques,
• medications,
• asthma devices, and
• psychosocial issues in asthma.

The ethnically and culturally correct instructional materials were written at appropriate reading levels to support maximum user comprehension Host community sites were responsible for providing space for teaching and for recruiting identified children with asthma. Parents and children were given attendance incentives related to asthma: mattress and pillow covers, peak flow meters, and spacer devices for inhalers. At the completion of the 5-week series, the family received a certificate of completion and a $15 gift certificate for groceries. Parents attending classes were assessed on their knowledge of asthma and its management for children and on their asthma management behaviors before and after instruction.

Evaluation Design:
This study used a pre-post test design for a large single cohort. Parents were surveyed at baseline and immediately after the classes. Follow-up assessments were made at 3, 6, and 12 months following the intervention. The study did not use a control group because the primary goal of this outreach effort was to educate as many community residents as possible about asthma and to study whether this effort provided effective education for the participants. A 16-item, multiple-choice quiz tested the participant’s knowledge about asthma self-management, including asthma symptoms, triggers, prevention, and correct use of devices and medications. A 21-item asthma control survey tool evaluated the parents’ perception in controlling the child’s asthma symptoms, triggers, and warning signs. Responses were based on a 3-point scale ranging from “almost never” or “sometimes” to “almost always.” A 33-item asthma quality-of-life survey Likert-type response scale related to childhood asthma was also administered. It was designed to assess parental perception of self-efficacy in controlling asthma, using resources and functioning with psychosocial stressors.

Sample Size:
The sample included 267 primarily African-American parents or primary caregivers of asthmatic children aged 18 months to 16 years.

Outcome Measures:
Asthma knowledge, asthma control, and asthma quality-of-life

Results:
The average test score on asthma knowledge before the intervention was 81% for parents. Immediate post-instructional test scores were significantly better, with an average of 94%. Compared with the asthma knowledge scores at the end of the classes (post test) the asthma scores at 3 months decreased slightly. Similarly, asthma knowledge scores at 6 months and 12 months were not significantly different from post test. Overall, the participants retained similar levels of asthma knowledge for up to a year. Both asthma control and quality of life scores increased 3 months after the classes, and the increased scores were significantly different from the post-test scores. The higher scores remain statistically significant at 6 months and 12 months after the classes (all p<0.05)*.

Asthma control and quality of life were based on parental perception rather than on clinical outcomes. Since the community asthma prevention program classes were open to the entire community, it was difficult to obtain comprehensive medical records to assess asthma control directly.

*In asthma quiz, the changes in scores are in proportion correct; in asthma control and asthma quality of life, they are improvements in sums of raw scores. The items in these two questionnaires were coded “1,” “2, and “3” for “almost never,” “sometimes,” and “almost always,” respectively. A 1-point average increase in raw score translates to improvements in one response category. For example, the parent may report less trouble in managing the child’s asthma, from “almost always” to “sometimes.”

Materials available:
You Can Control Asthma books for families and children are available both in English and in Spanish from:

The Asthma and Allergy Foundation of America (AAFA)
1233 20th Street, NW, Suite 402
Washington, DC 20036
Toll-free hotline: 1-800-7-ASTHMA (1-800-727-8462)
Tel: (202) 466-7643
Fax: (202) 466-8940
E-mail: info@aafa.org