Evid Based Nurs doi:10.1136/ebnurs.2011.100305
  • Child health
  • Randomised controlled trial

Power of peer leaders in improving self-management skills among adolescents with asthma

  1. Nihaya Al-Sheyab
  1. Department of Maternal and Child Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
  1. Correspondence to Nihaya Al-Sheyab
    Department of Maternal and Child Health Nursing, Jordan University of Science and Technology, PO BOX 3030, Irbid 22110, Jordan; nasheyab{at}

Commentary on: [CrossRef][Medline][Web of Science]Google Scholar

Implications for nursing practice and research

  • Peer-led programmes appear to be beneficial for adolescent with asthma.

  • Boys appeared to benefit more from the programme as did those with low-socioeconomic status and non-white participants.

  • Wider use should be made of developmentally appropriate adolescent peer-led education programmes inside and outside the school in improving important health outcomes.

  • Further research is needed to evaluate the effectiveness of such programmes over a longer period of time to confirm their sustainability and cost benefit.

  • Research is needed to further investigate the differences noted in this study in relation to gender, socioeconomic status and race.


Asthma is one of the most common chronic diseases among adolescents1 who often have poor self-management skills.2 Appropriate adolescent peer-led education programmes can be very effective in improving important health outcomes.3


This study aimed to evaluate the effectiveness of a self-management programme led by peer leaders compared with a similar one led by adults during a 1-day camp.

Using a randomised controlled trial, Rhee et al recruited a total of 112 adolescents, aged 13–17 years, through flyers and referrals from physicians and school nurses in the north east of the USA. Eligible participants were then randomly assigned to either the peer-led or the adult-led group.

Data were collected using two questionnaires (the Child Attitude Toward Illness Scale and the Pediatric Asthma Quality of Life Questionnaire), which were administered at baseline and immediately after the intervention and then at 3, 6 and 9 months. Twelve adolescent peer leaders received an intensive, structured 3-week training sessions before the camp. Paired peer leaders were assigned into groups of a maximum of 10 participants and they conducted the workshop using the adapted Power Breathing Programme.


Although both groups showed significant improvements, the findings of this study were in favour of the peer-led programme. Adolescents who attended the education programme led by their peers, who also have asthma, reported significantly greater improvement in quality of life at 6 months and 9 months, and significantly better attitudes toward asthma at 6 months. Interestingly, this study found that intervention outcomes were directly affected by gender, race and socioeconomic status of participants; where males, non-whites, and those with lower socioeconomic status had benefited more from the intervention.


These findings are consistent with the current evidence in this topic and confirm that utilising adolescent peers as educators to improve self-management skills among teenagers with asthma is an innovative method that can be more effective than other traditional interventions. This study is one of a few studies that implemented an age-appropriate programme for adolescents.4 5 Rhee et al used a strong design in which the control group also received an intervention led by adults – this is a major strength as previous studies did not provide any intervention for the control group.4 5 The authors also blinded the participants to their group allocation, recruited an adequate sample size and used valid and reliable instruments. Another strength of this study is that the peer leaders were slightly older than the participants, received intensive training and had asthma, which in turn might have maximised the benefits of the intervention.

While this study is the first non-school based peer-led asthma programme, it would be interesting to find out whether recruiting peer leaders who are familiar to the participants before the camp would have a better effect on outcomes. For example, if the intervention was school based, then recruitment of peer leaders could have been from the same school, as school setting has proven successful in improving quality of life among adolescents with asthma in Jordan5and Australia.4 Female peer leaders were two thirds of the total number, thus re-evaluation of recruitment methods of adolescent peer leaders is necessary to attract more males to be positive role models.


  • Competing interests None.


Free Sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EBN.
View free sample issue >>

EBN Journal Chat

The EBN Journal Chat offers readers the opportunity to participate in discussion about research articles and commentaries from Evidence Based Nursing (EBN).

How to participate >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.