An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: a randomised controlled trial

Abstract

Objective: To assess the outcomes of an education intervention for childhood asthma conducted by Australian Indigenous health care workers (IHCWs). Design and setting: Randomised controlled trial in a primary health care setting on Thursday Island and Horn Island, and in Bamaga, Torres Strait region of northern Australia, April 2005 to March 2007. Participants: 88 children, aged 1–17 years, with asthma diagnosed by a respiratory physician (intervention group, 35; control group, 53; 98% Indigenous children). Interventions: Children were randomly allocated to: (i) three additional asthma education sessions with a trained IHCW, or (ii) no additional asthma education. Both groups were re‐assessed at 12 months. Main outcome measures: Primary endpoint: number of unscheduled visits to hospital or a doctor caused by asthma exacerbation. Secondary outcomes: measures of quality of life (QoL) and functional severity index; asthma knowledge and understanding of asthma action plans (AAPs); and school days missed because of wheezing. Results: The groups were comparable at baseline (except for asthma severity, which was adjusted for in the analysis). There were no significant differences in the primary outcome (number of unscheduled medical visits for asthma). School children in the intervention group missed fewer school days because of wheezing (100% < 7 days v 21% of those in the control group missed 7–14 days). Significantly more carers in the intervention group could answer questions about asthma medication, knew where their AAP was kept (84% v 56%), and were able to describe the plan (67% v 40%). In both the intervention and control groups (before‐and‐after comparison), there was a significantly reduced frequency of asthma exacerbations, as well as an improved QoL score and functional severity index, with no significant differences between the groups. Conclusions: A community‐based asthma education program conducted by trained IHCWs improves some important asthma outcomes in Indigenous children with asthma. Trial registration: Australian Clinical Trials Registry ACTRN012605000718640.

Spirometry reference values in Indigenous Australians: a systematic review

“…All the studies included in this review have important shortcomings that limit the reported findings. In previous studies conducted by members of our group using unadjusted values for spirometry, Indigenous children with lung disease (specifically asthma 38 and bronchiectasis 39 ) often had results within the healthy range for people of European ancestry. For example, the mean FEV 1 and FVC values in the asthma study were 95% predicted (SD, 18%) and 100% predicted (SD, 17%), respectively 38 .…”

“…In previous studies conducted by members of our group using unadjusted values for spirometry, Indigenous children with lung disease (specifically asthma 38 and bronchiectasis 39 ) often had results within the healthy range for people of European ancestry. For example, the mean FEV 1 and FVC values in the asthma study were 95% predicted (SD, 18%) and 100% predicted (SD, 17%), respectively 38 . It is possible that a study that includes only healthy Indigenous Australians (strictly defined and with careful examination of medical history) will find spirometry reference values for Indigenous Australians similar to those for people of European ancestry, or requiring only a small adjustment factor.…”

Carers' perspectives on an effective Indigenous health model for childhood asthma in the Torres Strait

“…Rarely have the views of uses of the service been evaluated. Having documented the positive asthma outcomes of the education intervention program, we sought to obtain parents'/carers' perspective of the service model used so as to characterise the aspects of a clinical service model that lead to improved health outcomes from a community perspective. The seven themes generated from the parents'/carers' perspective relate to the cultural aspects (established rapport/caregiver satisfaction, local‐based approaches with involvement of HCW) and the high level of expertise in content and local issues (clear communication, quality service delivery, professional approach, clear transfer of education).…”

“…The health worker conducting the 12‐month follow‐up interview was not the same IHCW who provided the additional education sessions, and the doctors were not present when the interview took place. Results for the intervention study have been described elsewhere …”

“…Prior to our study, there has been a paucity of data of such a model from the Indigenous community perspective subject to scientific rigour (at a randomised control trial level, RCT) . We undertook a National Health and Medical Research Council‐funded RCT in the Torres Strait region to assess the outcomes of an education intervention for childhood asthma conducted by Indigenous health care workers (IHCWs) . While we saw improvements in some important asthma outcomes in those randomised to the asthma education model (e.g.…”