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Published on: November 4, 2010
A community-based strategy for improving asthma management and outcomes for preschoolers
Sally E Findley1, Gloria Thomas, Rosa Madera-Reese
1Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA. sef5@columbia.edu
Insights
A multi-layered asthma management program significantly reduced symptoms and healthcare visits for preschool children. Parent and provider education yielded the greatest improvements in asthma control for young children.
Area of Science:
- Pediatric Pulmonology
- Public Health Interventions
- Asthma Management
Background:
- Asthma affects nearly 1 in 10 preschool children, yet few management programs target this age group.
- Existing asthma programs often lack a focus on parental education and engagement.
- Preschoolers with asthma face significant challenges including daytime/nighttime symptoms, daycare absences, and emergency visits.
Purpose of the Study:
- To evaluate the effectiveness of the Asthma Basics for Children program, a multi-layered intervention for preschool children with asthma.
- To assess the impact of varying levels of program participation (center staff, parents, physicians) on asthma outcomes.
- To determine if a combined parent and healthcare provider education approach yields superior results.
Main Methods:
- Implementation of the Asthma Basics for Children program in 31 Northern Manhattan daycare centers from 2003-2008.
- Program components included educational activities for center staff, parents, and children, plus PACE training for physicians.
- Data collected on parent-reported trigger reduction, communication with physicians, and self-efficacy, alongside objective measures of child's asthma symptoms, daycare absences, ED visits, and hospitalizations.
Main Results:
- Following program participation, 80% of parents felt confident managing their child's asthma, and 85% reduced triggers.
- Significant reductions were observed in children's daytime symptoms (78% to 42%), nighttime symptoms (81% to 49%), daycare absences (56% to 38%), ED visits (74% to 47%), and hospitalizations (24% to 11%).
- The greatest improvements occurred when both parents and healthcare providers participated, with asthma-related daycare absences dropping from 62% to 32% and ED visits from 72% to 37%.
Conclusions:
- A multi-layered approach to asthma management is effective in improving outcomes for preschool children.
- Parental engagement and education are crucial for reducing asthma triggers and improving self-management.
- Combined parent and healthcare provider education demonstrates the most significant positive impact on reducing asthma-related morbidity in young children.
Abstract:
Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003-2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p < .001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar = 3.77, p = .052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar = 11.1, p < .001), ED visits (72% to 43%, McNemar = 19.2, p < .001), and hospitalizations (24% to 11%, McNemar = 5.54, p = .018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar = 9.8, p = .001), ED visits from 72% to 37% (McNemar = 14.4, p < .001), and hospitalizations from 35% to 15% (McNemar = 8.33, p = .003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.
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