Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: California (cont'd)
A Controlled Trial of Two Forms of Self-Management Education for Adults with Asthma
Institute for Healthcare Research, American Institutes for Research
Palo Alto, CA
Sandra R. Wilson, PhD
In 1986 "A Controlled Trial of Two Forms of Self-Management Education for Adults with Asthma" was conducted with patients of the Kaiser Medical Centers in Santa Clara, Sacramento, San Francisco, Redwood City, and San Jost/Santa Teresa, CA. Individual and group asthma education programs were developed and evaluated to determine their cognitive, behavioral, and clinical effects.
The small group program provides instruction regarding asthma and asthma management; discussion and group exercises encourage participant sharing of concerns, problem-solving, and mutual support. The program allows tailoring behavioral contracts and at-home activities to meet the needs of individual members of the group (typically 6-8 people). There were four 90-minute weekly sessions.
The individual program uses a diagnostic interview and an education planning form to help the educator identify and focus on an individual patient's specific asthma management needs. The educator chooses among 18 instructional modules (covering the same content included in the group program) to develop a program tailored to the needs of an individual patient. Education is delivered in three to five 45-minute meetings between the nurse and patient held at 1-week intervals. The individualized program requires approximately 180 hours of nurse time per patient.
Compared with the usual control, the self-management education programs were associated with significant improvements in control of asthma symptoms, MDI technique, and environmental control practices. Small group education also was associated with significant improvements in patient's level of physical activity (functional status). Acute visits were significantly improved in the group education program.
Both small group education and individual education were associated with significant benefits, but the group program was simpler to administer, better received by patients and educators, and more cost-effective. In addition, the small group program was packaged and disseminated as Breathe Easier by NAEPP. It continues to be used.
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