The effect of peer-led self-management education programmes for adolescents with asthma: A systematic review and meta-analysis

Abstract

Background: Adolescents with asthma face unique challenges due to hormonal changes, psychosocial development and healthcare transition. Peer-led self-management programmes may increase treatment adherence and social adjustment by addressing these challenges. The purpose of this study was to assess whether peer-led self-management programmes improve health outcomes for adolescents with asthma. Methods: Sixteen databases were searched in May 2015 for published and unpublished studies. Studies had to be randomised controlled trials (RCTs), include participants aged 10–19 years old with asthma, use a peer-led educational intervention that addressed self-management of asthma, and report a measure of health status or behaviour as an outcome. Trial quality and data extraction were based on pre-specified criteria. Results were pooled using a random-effects model with mean differences (MDs). Subgroup analysis was not possible due to limited data. Results: Of the 1,887 articles retrieved, 4 studies ( n = 1,937 participants) met the inclusion criteria. One study was excluded from meta-analysis due to unextractable data. There was a small, statistically non-significant increase in participants’ quality of life (MD = 0.70, 95% confidence interval [CI] = −0.29, 1.69, p = .16), and a small, statistically non-significant decrease in lung function (MD = −1.36, 95% CI = −9.98, 7.26, p = .76). In one RCT, interventions reduced asthma symptoms and improved self-management. Scarcity of data made meta-analysis unfeasible, and studies had unclear or high risk of bias. Discussion: There is limited evidence that peer-led self-management programmes improve quality of life or lung function for adolescents with asthma. RCTs investigating more diverse and longer term outcomes are needed.

How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions

“…Results from earlier reviews are supported by the results from this study and indicate that patient education interventions have positive effects, reducing the frequency of hospitalizations and emergency visits, improving self‐management of chronic illness, the self‐efficacy of young people with long‐term conditions and the quality of life of children with asthma. One review of the structured, more behaviourally focused programmes for youths with diabetes demonstrate beneficial results on young people's ability to manage their emotions, level of parent–adolescent conflict, adherence to medical treatment and sometimes metabolic control .…”

“…Adolescents encounter difficulties due to experiences of physical and psychosocial changes, social pressure from their peers and adolescent health‐care transition. Moreover, adolescents tend to be afraid, anxious and shameful of their illness …”

“…Describing and evaluating the content and impact of how patient education interventions can help to pave the way towards more efficient interventions. A few reviews provide evidence that patient education interventions have been beneficial for children and adolescents with asthma, diabetes, cancer, physical disabilities or across diagnoses (general paediatric care) . However, because of the great variety in type of intervention, setting, design and outcome measure of the included studies, it is not possible to conduct comparative analysis of the results that they present.…”

Peer Education and Peer Counselling for Health and Well-Being: A Review of Reviews

“…Peer education programs for adolescents with asthma were examined [43], and 16 databases searched for RCTs with participants 10-19 years old with asthma. Of the 1887 articles retrieved, just four (n = 1937 participants) met the inclusion criteria.…”

Facilitators, challenges and usefulness of an asthma educational programme

“…Although previous studies have highlighted the benefits of asthma educational programmes (Coombs et al, 2018; Warner et al, 2019; Zhong et al, 2017) they provide little information about the factors that can undermine the usefulness of such programmes. Among the challenges this study documented were lack of accessibility, limited specialist staff, low levels of motivation and experience, low levels of professional commitment, and limited availability of experts to design and implement programmes.…”