Objectives, methods and content of patient education programmes for adults with asthma: systematic review of studies published between 1979 and 1998

Abstract

Background-Education programmes for adults with asthma vary widely. Such variability suggests a lack of consensus on what works and what does not. The objectives of this paper are to describe asthma education programmes and assess their variability. Methods-A systematic review of reports published between 1979 and 1998 was conducted. Medline, the CINAHL database, the PsycINFO database, the Cochrane collaboration database, the Dissertation Index database, and cross referencing were used to identify educational interventions; 77 projects including 94 interventions that involved 7953 patients were analysed. A standard form was used to record characteristics of studies (design, setting, size, year, and country of publication), projects (theoretical framework, objectives), and education (methods, duration, intensity, educator, and content). Results-Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). When this information was available there were wide variations in training methods and content: training duration ranged from 0 (self-education) to 58 hours and the number of sessions from 0 to 36; training tools such as peak flow meters, diary cards or books were used in various proportions of interventions (19%, 27%, and 23%, respectively). The content of education also diVered widely between programmes. Conclusions-InsuYcient documentation of asthma education programmes for adults precludes their replication. This, together with excessive variability, reduces the possibility of identifying their most eVective components. A more systematic description of asthma training programmes should be promoted. (Thorax 1999;54:681-687) Keywords: asthma; patient education; self-management Education programmes for people with asthma have existed for a long time but what exactly "patient education" stands for remains elusive. Even a cursory overview of education programmes for asthma patients reveals that programmes vary widely in objectives, educational methods, intensity and duration, educator, and content. Such variability suggests a lack of consensus on what works and what does not in patient education.1 It precludes a meaningful evaluation of the overall eVectiveness of educating asthma patients such as could be achieved by a meta-analysis. Intervention variability has been a minor concern of previously published reviews.2 3 We therefore conducted a systematic review of published educational interventions for adults with asthma with the objective of describing asthma education programmes and assessing their variability. Methods IDENTIFICATION AND SELECTION OF STUDIESTo identify relevant studies we applied the algorithm "asthma and (education or training or self management)" to the Medline database , the Dissertation Index database , the Nursing and Allie...

A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma

“…67,72,[92][93]108,111 High-quality reviews of similar interventions for children suggest more mixed results. 73,92,93,104 Evidence on the optimal form and methods for delivery of selfmanagement education, 72,98,104,107,109,111 other types of psycho-educational programmes (e.g. psychotherapeutic approaches) 96,97,103,106,112 and multifaceted interventions 92,115,120 appears to be more sparse and a number of these areas have been identified for further research or consideration in ongoing Cochrane reviews.…”

“…Results of studies were tabulated and all but three studies showed positive effects on at least one outcome at one or more time points; however, no attempt was made to synthesise results qualitatively or quantitatively. A systematic review of patient education programmes for adults with asthma 109 summarised details of the content and methods applied in, but not results from, 94 studies of such programmes and concluded that interventions were generally poorly described and reported.…”

“…67,72,83,[107][108][109][110][111][112][113][114] A 1997 narrative review of interventions designed to enhance self-management 67 concluded, on the basis of a qualitative assessment of 18 trials which involved random assignment and sufficient sample sizes, that there was impressive evidence of the benefits of self-management education in adults in terms of a range of health and psychological outcomes. A review conducted at a similar time, 107 which provided little detail on its methods, focused specifically on self-management programmes incorporating self-treatment guidelines and was much more cautious in its conclusions, highlighting the need for further good-quality research on the important components of such interventions.…”

Benefit from the inclusion of self-treatment guidelines to a self-management programme for adults with asthma

“…In two recent reviews it was found that asthma education programmes (with or without guidelines for self-treatment of exacerbations) vary widely in their methods and content [36,37]. This makes it difficult to identify the most effective components of these programmes.…”

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

“…Written personalised asthma action plans (PAAPs) can be introduced as part of a structured educational discussion with a trained asthma healthcare professional. 43 Key components of an asthma educational programme 44 are shown in Box 5, and the components of a written PAAP 45 are shown in Box 6.…”