This study tested Open Airways (a well-known asthma self-management program) with inner-city African-American school children, ages 8 to 13, on self-care abilities, practices and health outcomes.  The school-based intervention is consistent with Orem’s Self-Care Deficit Theory of Nursing.  In this study, factors such as age, gender and number of siblings were considered possible influences on self-care practices.

A quasi-experimental design with pre and post-intervention measures was implemented in eight inner-city elementary schools, assigned by convenience to a treatment or comparison group.  The sample included 102 students with parent-reported asthma noted on a screening survey with 20-25% parental return rate across the schools. Data were collected at the beginning, two weeks and five months after the six weekly sessions (treatment group).  The students completed five surveys (asthma knowledge, asthma beliefs, self-care agency, asthma self-care practices, and self-perception) and an asthma diary all prepared for a third-grade reading level.

There were unexpected differences between the two groups at baseline. The control group was older (mean 11.2 vs. 10.3 years), and fewer children in the treatment group used controller medications (10% vs 26%) and quick-relief medications (50% vs. 77%).  The treatment group had higher rates of asthma emergency department visits in the previous year.

There were no significant differences between the two groups on any of the measures following implementation of Open Airways.  Children who scored higher in general self-care practices also had higher scores on asthma self-care. The researchers outlined likely factors in addition to differences between the groups initially. In addition, many students were not able to read at the third grade level (measurement tools).  The treatment group had significant gains in the use of peak flow meters but also had more urgent medical visits.  These changes could have been related to different initial asthma acuity and/or improved recognition of episodes needed treatment.

Research needs to consider access to health care, affordability of medications and the reading skills of study participants.

(Velsor-Friedrich B, Pigott T, Louloudes A. J Pediat Nurs 2004;19(4):247-256)

Comment:  This article was of interest because of what the academic researchers learned about the study population and how that can affect nursing research efforts. Conducting research on interventions with children should consider factors such as ages not just grade assignments, previous experience with interventions and actual care (such as differences between having a medication prescribed and filling the prescription).   --J.O.