Evidenced Based Strategies in African American Boys
Below are summaries of three evidence based strategies and intervention programs designed primarily in or for schools to help manage asthma symptoms in African American and urban living students.
1) Target audience: Urban African American High School students
Implementation: This program was set up in six urban high schools in Detroit, Michigan. Lung Health Surveys were sent to each high school for ninth through eleventh graders to complete during English class that will determine the eligibility of each student that could potentially participate in the program.
Program design: Overall, this program was designed to implement a web-based asthma management program for high school students in six Detroit high schools that was personally tailored to each eligible participant. After completing the Lung Health Survey, the student had to have physician diagnosed asthma along with one of the following: asthmatic symptoms within the last thirty days, have received medical care for asthma related symptoms within the last thirty days, or use of asthma medication in the last thirty days. If the student was eligible, their parents were sent a package explaining the intervention program. To participate, the parent and student signed their consent to participate. The program was built around three core areas of focus for the students to learn about and implement into their daily routine: taking medication, resources on how to get access to rescue inhalers and the importance of not smoking to lessen the effects of asthmatic symptoms.
The participants conducted a baseline survey, and from that were randomized based on school, grade level and a report from their physician. The treatment program consisted of four sessions to be completed over 180 days and it was available to access on school computers. Each session gave theory-based evidence of ways to change the student’s behavior, including education on what asthma is, how to effectively use an inhaler, and ways of identifying and avoiding personal triggers. Each participant in the web-based program would be sent specific messages based on their symptoms, attitudes and beliefs to help alter their negative behaviors. A follow up survey was given to each participant twelve months after they completed the four sessions.
Evaluation: The program was evaluated using a control group of participants who met the eligibility criteria and were also given four sessions to complete, but instead of receiving theory-based information and personalized education, control participants were restricted to reading only general asthma websites on their computers and were limited to 30 minute sessions.
Key Results: Overall, a web-based program that is available on school computers and tailored to each individual participant is not only effective, but it is also inexpensive as well as realistic to set up and implement. This program showed that more positive changes occurred from the program for participants in the treatment group who received a tailored management program. More participants in the treatment group were more likely to get an inhaler if they did not have one before beginning the program, as well as use it properly and as necessary. Participants that were in the treatment group also had fewer symptoms and hospitalizations than participants in the control group.
Theoretical Foundation: There was no theoretical foundation found in this intervention program.
Source: Found in ProQuest Public Health Database
Joseph, C. L. M., Peterson, E., Havstad, S., Johnson, C. C., & al, e. (2007). A web-based, tailored asthma management program for urban african-american high school students. American Journal of Respiratory and Critical Care Medicine, 175(9), 888-95. Retrieved from http://ulib.iupui.edu/cgibin/proxy.pl?url=/docview/199592982?
accountid=7398
2) Target Audience and Implementation: This program targeted Latino and African American high school students, who were in grades nine or ten and were drawn from five high schools to determine eligibility.
Program Design: The program design is called Asthma Self-Management for Adolescents (ASMA). This was an eight-week intensive program consisting of group and individually tailored based interventions. There was a total of three group sessions where educational information was distributed, including management tips, how to use medications as well as a peer support conversations. Alongside the group sessions, participants attended individually tailored face to face session at least once a week where they worked with a trained counselor on their specific needs and ways to cope with their symptoms, reinforced what was learned in the group sessions and began an academic detailing for the participant’s physician. During the eight weeks, the participant also filled out an asthma checklist that he/she brought to their physician along with the counselor, and the physician then filled out an asthma program plan specific to that individual and the symptoms they checked and brought into their appointment. The desire for working closely with the participant’s physician was to ensure the student was receiving proper medical care for their diagnosed asthma. Participants without a regular physician were given referrals to available doctors.
Evaluation: The program was evaluated using a control group of participants who were also eligible. Once each eligible participant completed their baseline survey, they were assigned to the treatment or control group depending on the severity of their asthma. The control participants did not get to participate in the specific eight-week intensive Asthma Self-Management for Adolescents program.
Key Results: Asthma Self-Management for Adolescents proved to be effective in lowering morbidity and emergency room care and effectively improved self-management of asthma in urban high school students. Treatment (ASMA) participants were much more likely to actively take steps to manage their asthma symptoms six months after completing the program and were also more confident in their ability to self-manage. For example, treatment participants were twice as likely to have gotten and actively use an inhaler to help lessen their symptoms. ASMA participants also had significantly less morbidity, 31% of participants had fewer night awakenings, 42% had fewer days where their activities had to be restricted, and 37% of participants had fewer days of missed school due to asthmatic symptoms after the twelve month follow up.
Theoretical framework: Social Cognitive Theory
Source: Found in ProQuest Public Health Database
Bruzzese, J., Sheares, B. J., Vincent, E. J., Du, Y., Sadeghi, H., Levison, M. J., . . . Evans, D. (2011). Effects of a school-based intervention for urban adolescents with asthma: A controlled trial. American Journal of Respiratory and Critical Care Medicine, 183(8), 998-1006. Retrieved from http://ulib.iupui.edu/cgi- bin/proxy.pl?url=/docview/862739212?accountid=7398
3) Target audience/Implementation: Inner-City, African American school aged children from an elementary school in Dallas, Texas with chronic asthma. Participants in the program were found based on past school medical records where forty perspective students were picked and their parents were mailed information regarding the program. Twenty-five of the forty attended a meeting to fully explain the specifics of the program. The physicians of each participant were also notified of their patient’s participation, provided a detailed explanation of the program and requested to release the full medical record and list of medications of the participant.
Program Design: This program was designed to use participants from a Dallas, Texas elementary school to measure their doses of medications, including inhaled anti-inflammatory agents (IAI) as well as inhaled bronchodilators (IBD) to prevent symptoms from getting worse. Each participant was given two peak flow meters and two space dividers to use when inhaling medication. One of each was to be kept at school and the other at home.
The program was thirteen weeks and set up where participants had their peak flow measured before school began and after school ended. If the participant read in the green range, they went onto class or home, indicating their airflow was good. If the participant read in the yellow range, they were given two puffs of an IAI and asked to wait for fifteen minutes before testing their peak flow again to make sure it is in the green range. If the participant read in the red range, they were given the prescribed IBD and asked to wait for fifteen minutes before testing their peak flow again. If the second test resulted in the yellow or green range, the participant was given the prescribed doses of IAI and could return to class or home. If the participant’s second read remained in the red range, the parents were notified immediately. Besides peak flow readings, each participant was asked to report any symptoms they were experiencing each morning before school.
For the weekends, the participants were sent home with the necessary amount of medication they may need and an At-Home log to journal problematic or concerning symptoms they experienced. The medication and log were collected before school the following Monday.
Evaluation: In its evaluation, the creators of the program found more information was needed on disseminating medication in schools for asthma, effective ways to reduce asthmatic triggers and how asthma and school absenteeism correlate to one another. In evaluating this program, they found a need to develop a more expansive program that would include four groups instead of just one to successfully evaluate the effectiveness of the program, including adding a control group, a group where participants can take their medications at school, a group where the participant takes their medication at home alongside education on asthma management for the parent and student as well as a group where participants take their medication at home, but neither them nor their parents receive asthma management education. In this future program, results will highlight the differences in where students can take their medication and how that affects their self-management of symptoms as well as how important parental and participant education on asthma can be.
Key Results: Overall, there were twenty-two participants in this program. Out of the twenty-two, eighteen had improvements on their peak flow meter readings going through the program. Fifteen of the participants were able to reduce how often they had to use their IBD medication, and participants were 75% less likely to have problems during the nighttime due to their asthmatic symptoms after completing the program.
Theoretical Framework: No theoretical framework was used in this program.
Source: Found in ProQuest Public Health Database
McEwen, M., Johnson, P., Neatherlin, J., Millard, M. W., & Lawrence, G. (1998). School-Based Management of Chronic Asthma among Inner-City African-American Schoolchildren in Dallas, Texas. The Journal of School Health, 68(5), 196-201. Retrieved from http://ulib.iupui.edu/cgi- bin/proxy.pl?url=/docview/215679740?accountid=7398
DISCUSSION
While I found all three of these programs to be effective, I believe the first program is the most feasible, cost effective and successful given the population of African American boys with chronic asthma that I am aiming to work with. The web-based approach makes it a realistic program to begin with, and being tailored to the individual will make the program more effective for each participant. Although web-based seems unrealistic, having the sessions accessible from school computers make it easier for the participant to complete and gain educational information to help them manage and cope with their asthma, as well as assistance with computers from teachers at school if the participant has difficulty using computers. The core behaviors that their tailored program focused on included identifying and avoiding triggers, which is extremely important to incorporate in my program as well, and neither of the other studies specifically touched upon this issue in their programs. I plan to use the web-based approach using computers at the school(s) in my program, as well as the tailored approach, but will also add a way to have optional web-based group sessions, similar to what the second program did, where participants can communicate with other students with asthma for moral support of each other as well as an arena to communicate concerns and/or information to each other via an online forum so that education can come from the tailored program, but also from other participants. The group sessions will be available for the participants and a separate group session will be available for parents so they can also receive peer support and education from other parent’s or caregiver’s who primarily care for the participant.
Both of the other programs required overly extensive communication and interaction with the participant’s physician, and although physician program plan or release of medical records and advice from the diagnosing physician may help with self-management of the participant, it will limit my program’s hopes to help as many people in my population because not all of my targeted potential participants will have a regular physician due to their socioeconomic status. The second study does offer referrals for those without physicians, but that still raises the issue of family’s without health insurance and a general lack of finances in finding proper and consistent medical care for the program. It is important to include physician support for those participants who have a regular physician, and like the second program, referrals will be given to those who do not have a regular physician, but it will not be a necessity to have a physician to be part of my program as to not limit participation due to financial strain on the family’s of those affected my asthma.
