Do School-based Asthma Education Programs Improve Self-Management and Health Outcomes

Objective: To conduct a systematic review of the literature on effects of school-based asthma education programs on three intermediate outcomes (knowledge of asthma, self-efficacy, and self-management behaviors) and four health outcomes (days with symptoms, nights with symptoms, quality of life, and school absences). We hypothesized that asthma education would increase knowledge and self-efficacy which would improve self-management behaviors and health outcomes.

Methods: We searched PubMed, CINAHL, and the Cochrane Controlled Trials Register for controlled trials that assessed school-based asthma education programs. Inclusion criteria included publication in English and enrollment of children aged 4-17 years with a clinical diagnosis of asthma or symptoms consistent with asthma.

Results: Two investigators screened titles of 358 articles and retrieved 111 for further review. Twenty-five met the inclusion criteria. Most school-based asthma education programs provided comprehensive education consistent with national guidelines to groups of children. Eighty-three percent of studies that examined effects on knowledge, self-efficacy, and/or self-management behaviors found that school-based asthma education improved these intermediate outcomes. In contrast, only half of studies that assessed quality of life, days with symptoms, and/or nights with symptoms reported that education was associated with better outcomes. Only one third of studies that evaluated school absences found that children who received education had fewer absences.

Conclusion: School-based asthma education programs improve children's knowledge, self-efficacy, and self-management behaviors but are less effective in improving health outcomes. Greater collaboration between educators and health professionals and better access to appropriate care may be needed to improve the health of children with asthma.