Evaluation of a School-Based Asthma Education Program: Iggy and the Inhalers

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1 Evaluation of a School-Based Asthma Education Program: Iggy and the Inhalers Kathleen K. Shanovich, PNP; Catherine F. Mickel, DNP; Daniel Jackson, MD; Michael Evans, MS

2 Childhood Asthma Affects approximately 11% of children nationwide Leads to activity limitation, missed school days, ER visits, and hospitalizations Poor and minority disproportionately affected Often receive asthma care acutely Missed opportunities for education School-based asthma education School nurses can outreach children at high risk for poor asthma control NAEPP guidelines recommend asthma education at all points of care, including schools (CDC, 2013; NIH, 2007)

3 Iggy and the Inhalers (Iggy)* Evidence-based asthma education program Covers six teachings points recommended by NAEPP guidelines Asthma physiology Symptoms Actions of medications Inhaler technique What to do about worsening symptoms Steps to avoid triggers Implementation took place in the Madison Metropolitan School District (MMSD) *(NIH, 2007; Thomas & Ashwal, 2014)

4 Objectives Purpose - To evaluate the success of the Iggy and the Inhalers asthma education program and the extent to which our objectives have been achieved: Increase child knowledge of asthma physiology, symptoms, medications, and triggers as evidenced by pre-test and post-test results Increase family awareness of asthma education and the importance of disease management Cultivate collaboration between school nurses and local asthma providers

5 Study Population Madison Metropolitan School District (MMSD) Urban school district in 2 nd largest Wisconsin city 27,186 students, half low-income, 1 in 4 English language learners, 56% minorities 13% of MMSD children have asthma Seven schools selected for implementation with highest free and reduced school lunch rates: Mendota (76%), Glendale (74%), Schenk (71%), Allis (71%), Lincoln (67%), Falk (77%) and Leopold (74%) (MMSD, 2015)

6 Procedure Children enrolled in the MMSD with asthma between the ages of seven to eleven Eligibility criteria: Current diagnosis of asthma in school electronic health record Receiving asthma medications in the school health office School nurses responsible for identifying eligible children Iggy education flyer sent home notifying parents Opportunity to opt out children

7 The Iggy Program Asthma education video, poster, comic book, sticker, and trading cards for children ages 7-12 (Thomas & Ashwal, 2014) Materials cost $5 per child x 173 children = $865 Tested for appropriateness via focus groups in Chicago and Madison asthma camp (Thomas & Ashwal, 2014) Based on best practice guidelines (NIH, 2007)

8 Intervention 30 minute sessions: Introduction Pre-test Video Discussion Post-test Children take home comic books, stickers, and trading cards Instructed to share with parents

9 Evaluation Procedures Description of participants from school database Age, gender, ethnicity Frequency of asthma health office visits for each school Asthma knowledge pre/post-tests Identical with six multiple-choice and true/false questions Qualitative data from children, parents and school nurses

10 Results Seven schools participated Twenty-one teaching sessions 173 students participated 6 children refused None opted out by parents One-month follow-up tests completed on 147 children 31 parents interviewed post intervention Feedback received from all 7 school nurses

11 Results: Demographics Demographic Range Mean Age years Gender Female Male Ethnicity African American Hispanic Caucasian Asian Number Percentage 45.7% 54.3% 63.6% 13.3% 20.2% 0.03% Grade 1 st 2 nd 3 rd 4 th 5 th % 17.9% 23.7% 28.9% 28.3%

12 Results: Asthma Knowledge Pre vs post-test scores increased by a mean of 1.10 points out of six. Statistically significant (p<0.0001) Lower pre-test associated with greater improvement in post-test No apparent association between age and magnitude of improvement (p = 0.47) One-month post-test data show retention of knowledge with continued significant improvement from baseline (p< ) Pre-test Post-test 1-Month Post-test Mean Score

13 Results: Child Perceptions 158 children provided qualitative responses. Overall well received 7 children did not like the Iggy program Positive Response Areas Iggy video/characters Iggy take-home materials Learning about asthma Direct Quotes I liked how they had the bad villains and how Iggy was made out of an inhaler. I like the gifts. That they taught me a lot of things I didn t know but in words I can understand

14 Results: Parent Response 31 parents provided Iggy feedback Overall positive No parents upset about the program 25 reported that their child was enthusiastic about Iggy 4 had not spoken with their child about the Iggy program Positive Feedback Areas Sharing Iggy materials Behavior changes School taking action Direct Quotes As soon as he got out of the car, he pulled it out and started reading to me. Said, mom, I m allergic to this, this, and this. He had been resistant to using a chamber, but he remembered Iggy said the inhaler won t work if you don t have a chamber. He even told his doctor about it. I like the extra support from the school and feel like it is helpful.

15 Results: Parent Response Areas for Improvement None Program content School process Direct Quotes Not that I can think of She also has colds as a trigger, and that was not listed in the comic book. Maybe when they are having an asthma attack, find a better way to communicate when the last inhaler was given.

16 Results: School Nurse Response Overall positive and enthusiastic Pleased with collaboration with asthma specialty providers The program was very well organized and followthrough was exceptional. Identified barriers/suggestions for change

17 Challenges Children had difficulty understanding specific test questions Recommend rewriting questions at lower reading level. Teaching sessions Limit number of children in group Name tags on children in attendance Need school support personnel present (such as school nurse) Hold in quiet room Good AV equipment Desks/tables

18 Sustainability Pursue continued funding Dissemination of findings Explore translation into rural school districts Limited resources School nurses covering multiple schools How does the Iggy program effect asthma control? Missed school days Quality of life (use of albuterol, night time awakenings, etc) ED visits/hospitalizations

19 Conclusion Iggy and the Inhalers is a successful school-based asthma education program Collaboration between school nurses and asthma specialty providers Feasible Beneficial to community-wide pediatric asthma treatment efforts School-based asthma education allows school nurses to play a role in community-based asthma care

20 Acknowledgments MMSD students and parents MMSD health services: Health services coordinator: Sally Zirbel-Donisch, MS, RN School nurses Health aides Cat Mickel, DNP Wisconsin Asthma Coalition Dr. Alex Thomas & Gary Ashwal Booster Shot Comics

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