Clinical study
Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial

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Abstract

Purpose

We conducted a randomized clinical trial to assess the effectiveness of a newly established education program for adults with asthma. The program was designed to improve patients’ health and functional status.

Subjects and methods

Hospitalized patients with asthma were randomly assigned to immediate education or a 6-month waiting list. The education program consisted of three group sessions, delivered by trained educators, and focused on improving patients’ self-management skills. Of 253 eligible patients, 131 agreed to participate (66 assigned to immediate education, 65 controls) and 115 (88%) completed the follow-up assessment at 6 months.

Results

At follow-up, most indicators of self-management skills and health and functional status had improved significantly among educated patients, but similar improvements were also seen among controls. The trial arms differed significantly on only four variables: patients in the immediate-education group were more likely to develop confidence in their asthma treatment (odds ratio adjusted for baseline [OR] = 2.9; 95% confidence interval [CI]: 1.0 to 8.1), to improve their knowledge of correct inhalation technique (OR = 2.4; 95% CI: 1.0 to 5.7), and to improve knowledge of the peak flow reading that warrants calling a physician (OR = 3.1; 95% CI: 1.4 to 6.7), but they improved less on the Asthma Quality of Life Questionnaire “activity” score (difference: −0.4 on a 1 to 7 scale; 95% CI: −0.8 to 0.0). Use of health services during follow-up was similar in the two groups.

Conclusion

The education program did not enhance patients’ health and functional status, despite improving a few self-management skills. These results underscore the need for controlled evaluations of education programs.

Section snippets

Program description

The educational intervention was based on the theoretical framework of self-regulation (22), which postulates that patients have symptomatic impairment, choose among possible solutions, apply the selected strategy, and evaluate its results. The program was based on the assumption that reinforcement mechanisms, such as providing feedback on treatment and sharing responsibility for care with patients and their families, would improve coping with asthma and increase adherence to recommended

Results

Only about half of eligible patients agreed to participate (Figure). Most participants had asthma for more than 10 years and had been hospitalized before enrollment (Table 1). About 30% reported having received asthma education previously. At baseline, the two treatment groups had similar characteristics (Table 1).

In the immediate-education group, only 35 patients (53%) attended all three scheduled sessions, 11 patients (17%) attended two sessions, 6 patients (9%) attended one session, and 14

Discussion

Patients hospitalized with asthma benefited only moderately from the education program that we evaluated. Although most patient outcomes improved significantly between baseline and follow-up among patients in the immediate-education group, similar improvements also occurred among those on the waiting list. Only a handful of variables differed significantly between the two groups. Hence, few favorable outcomes could be attributed to the education program. Had we applied a correction for multiple

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    This study was supported by Grant 32-39701.93 from the Swiss National Science Foundation, Berne, Switzerland.

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