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School-based self-management interventions for asthma can improve health outcomes

A systematic review shows that primary school-based self-management interventions can improve outcomes for school children with asthma, but it is important to actively involve parents for positive results

A systematic review published in npj Primary Care Respiratory Medicine has highlighted that asthma self-management interventions delivered in schools can improve the outcomes of primary-aged children with asthma. It also showed that effective interventions involved parents, guardians or care-givers in attending a session or taking part in phone/video communications. Minimal involvement (such as receiving a letter about asthma) was not associated with effective interventions.

Study aim

The aim of the study was to find out how effective school-based self-management interventions were for primary school children with asthma. The researchers also wanted to determine which components were associated with successful programmes.

With interventions conducted between 1992 and 2019, the review included 23 studies carried out in Canada, China, Spain, Thailand, the United Kingdom, and the United States. Some studies used standard programmes, such as Open Airways for Schools (OAS), and others developed novel interventions. The interventions could be delivered by healthcare professionals or trained school teachers.

Effectiveness of interventions

Of the 23 intervention studies, 12 had positive effects: reducing days off school, improving asthma control or reducing the need for urgent medical care in the primary school children with asthma.

Across the studies, substantial involvement of parents, guardians or care-givers was a crucial component of the interventions for the children.

In fact, parental involvement was the only component which was considered essential for a successful intervention, probably because parents still have a significant role in making decisions for children in this age group (6 - 12 years).

Access to healthcare and treatments is essential

Socio-cultural beliefs, physical inaccessibility and lack of education and information are barriers to accessing healthcare, particularly in low- and middle-income countries. School-based interventions are one way to bring healthcare to children and their families.

Future studies

Gaps still remain in the understanding of school-based self-management education in younger children, particularly in low- and middle-income countries.

This research was carried out by the NIHR Global Health Research Unit on Respiratory Health (RESPIRE) and the paper was led by Siti Nurkamilla Ramdzan, based at University of Malaya, Malaysia.

She said:

Understanding the importance of active parental participation informed the development of a school-based programme for primary schools in Malaysia. We developed the programme which focuses on the child with active parental involvement, their teachers and friends.

Siti Nurkamilla RamdzanLead author

Professor Hilary Pinnock, Co-Lead for the RESPIRE Chronic Respiratory Diseases Research Programme, and Lead for Optimising Management of Asthma Attacks at the Asthma UK Centre for Applied Research, who contributed to the review said:

Health education in schools is an important strategy both for helping children learn to manage their condition and for influencing families especially in contexts where there are barriers to accessing health care. It is encouraging to find this is an effective approach to improving asthma care.

Professor Hilary PinnockLead for Optimising Management of Asthma Attacks at the Asthma UK Centre for Applied Research

Read the paper

This publication is available from npj Primary Care Respiratory Medicine

Cite as

Ramdzan, S.N., Suhaimi, J., Harris, K.M. et al. School-based self-management interventions for asthma among primary school children: a systematic review. npj Prim. Care Respir. Med. 31, 18 (2021). https://doi.org/10.1038/s41533-021-00230-2

Image credit: NIHR Global Health Research Unit on Respiratory Health (RESPIRE)