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A randomized field trial of ACINDES: a child-centered training model for children with chronic illnesses (asthma and
J A Tieffenberg1, E I Wood, A Alonso
1Research Division, Self-Help Training Project of ACINDES, Association for Health Research and Development, Buenos Aires, Argentina. info@acindes.com.ar
Insights
A child-centered training program significantly improved health outcomes for children with asthma and epilepsy. The play-based model empowered children and parents, leading to better self-management and quality of life.
Area of Science:
- Pediatric chronic disease management
- Health psychology
- Educational interventions
Background:
- Chronic illnesses like asthma and epilepsy significantly impact children's health, activity, and quality of life.
- Traditional management models may not fully engage children and families in self-care.
- A child-centered approach could enhance treatment adherence and outcomes.
Purpose of the Study:
- To evaluate a child-centered, play-based training model for self-management of asthma and epilepsy in school-aged children.
- To assess the impact of the intervention on children's and parents' knowledge, attitudes, behaviors, and clinical outcomes.
- To compare the effectiveness of the experimental model against a control group.
Main Methods:
- A randomized field trial involving 355 Spanish-speaking children (6-15 years) with moderate to severe asthma or epilepsy in Buenos Aires, Argentina.
- A child-centered training model using play techniques, with simultaneous children's and parents' groups, led by trained teachers.
- Data collection included home interviews, medical/school record monitoring, and the Children Health Locus of Control Scale (CHLCS) at baseline and 6/12 months post-intervention.
Main Results:
- Experimental group children showed significant improvements in knowledge, beliefs, attitudes, and behaviors for both asthma and epilepsy compared to controls.
- Parents reported increased knowledge of asthma and epilepsy. Fears of child death decreased significantly in the experimental group.
- Children in the experimental group experienced fewer asthma and epilepsy crises, reduced physician visits, and decreased school absenteeism. Increased internality on the CHLCS was observed.
Conclusions:
- The child-centered, autonomous training model was successful in improving health, activity, and quality of life for children with asthma and epilepsy.
- Reinforcing children's autonomous decision-making through play-based learning is key to the program's success.
- This model offers a viable strategy for enhancing chronic disease self-management in pediatric populations.
Unlabelled:
A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8-10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls = .69 for epilepsy and .56 for asthma, with sigma2 = .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain = .62 (sigma2 = .0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P = .036 and P = .026). Visits to physicians showed a significant decrease for those with asthma (P = .048), and emergency visits decreased for those with epilepsy (P = .046). An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P < .01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winter P = .006, and spring P = .029; for the group with epilepsy, P = .011).
Conclusion:
The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.
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