Alberta Asthma Centre

RAP EVALUATION - ROARING ADVENTURES OF PUFF (RAP) PROGRAM REDUCES ASTHMA MORBIDITY

Feedback/Comments

From Instructors

"It was fun to see what the kids came up with and how willing they were to learn."
"I enjoyed the opportunity to be involved in the school, working with the children and helping them understand their asthma."
"The best part was how they shared their stories"
"I was amazed at how much the kids - even the older ones - really got attached to Puff!"
"Puff really drew them out!"

** picture above: Respiratory Therapist Jocelyne King role plays RAP activities using Puff the Dino

From Children

"The teachers were very nice and helpful."
"The activities were fun."
"I plan to avoid getting an attack if I can help it."
"I'm a lot more in touch with what is going on in my body."

This poem was written by a RAP participant after learning about his asthma.

From Parents

"It was very useful for my child to see other children who had to live with asthma and that they are not different. He really enjoyed himself."
"My child was more relaxed in talking about her asthma. She loved RAP!"
"RAP improved his self-awareness and confidence."
"RAP helped my child become more responsible for her asthma."

Randomized control studies Centre for Disease Control case study

ROARING ADVENTURES OF PUFF (RAP) PROGRAM REDUCES ASTHMA MORBIDITY
E Wong, S McGhan, H Wells, P A Hessel, P Mundane, V Boechler, D Befus, C MajaesicAlberta Asthma Centre, University of Alberta, Edmonton, AB, Canada

To download the above document, click here. It is in a Microsoft Power Point Format.

Abstract

Rationale: There is still ongoing debate as to the impact of asthma education on quality of life, level of control and health-care utilization. We hypothesized that children with asthma who receive an education program will improve their quality of life, level of asthma control, asthma management behaviour and will have reduced health-care utilization compared to children in the control group. Methods: 34 schools from three health regions in Alberta, Canada, were randomized to receive either the RAP program or usual care. The RAP program is a six-week childhood asthma education program administered by health professionals in the schools. Outcomes were measured from both the parent and child prior to the intervention and at six and 12 months using the “Me and My Asthma” Questionnaire, “Parent Asthma Questionnaire,” and the “Pediatric Quality of Life Questionnaire.” Results: 130 children enrolled in the intervention group, and 165 children enrolled in the control group. Improvements following the RAP program were significantly greater (p<0.05) in the intervention group in the following areas: missed school days, unscheduled doctor visits, limitations in the kind of play, changing medication due to worsening asthma, smoke exposure in the home, use of peak flow meter, and avoidance of triggers. Discussion: Our results showed that the most significant impact of asthma education was seen in asthma management behaviour. Concurrently, we noted an improvement in quality of life with less limitation in activity and fewer missed school days. Conclusion: Our study suggests that a multi-level, comprehensive, school-based asthma education program is feasible and effective in improving health outcomes.

Background

Prevalence of childhood asthma is increasing.
Asthma is not optimally controlled.
Studies show that few families receive individual or group asthma education
Education needs to be accessible, comprehensive and effective
Accessing children at school has shown to be a feasible approach.

Hypothesis

We hypothesized that school-aged children with asthma who participated in the Roaring Adventures of Puff (RAP) program will exhibit greater asthma self-management behaviour, will have reduced symptoms and health care utilization.

Study Procedure

Urban and Rural Schools randomly selected (n= 34)

School Health Survey Administered
(n= 3986)

Pre-assessment of children and parents

Schools Randomly Assigned
Control group Intervention (RAP) group
(n=165) (n=130)

6-month post-assessment
(n=220)

12-month post-assessment
(n=197)

RAP Intervention Phases

Inform primary care physician and obtain written action plan
- Provide letter outlining the program
- Invite input and suggestions
- Provide sources of asthma guidelines
- Request a specific, written asthma action plan
Educate parents and school staff
- Obtain input on needs
- Provide overview on asthma management
- Agree on process to address school asthma guidelines
- Provide overview of the education program
- Outline how the parents and staff support children with asthma
Teach six one-hour RAP sessions at school to children with asthma
- Facilitate group interaction and team work Encourage goals setting
- Use interactive games and learning activities
- Teach self-monitoring and action plan use
- Discuss triggers and avoidance measures
- Explore rationale of medication and assess use
- Facilitate symptom recognition and early action
- Discuss feelings, lifestyle, exercise and fears
- Share what they learned with others

Data Analysis

The Pearson chi-square test used to compare the RAP vs. control group and drop out vs. non-drop outs.
The McNemar test used to compare within the RAP and control groups.

Results

Demographics

Mean age 8.56 yrs; of diagnosis 4.6 yrs
61.5% male
86% lived in a city or town
37.8 had other medical problems
80% had seasonal asthma
69% asthma rarely interferes with lifestyle
17% used a short course of steroids last yr.
19.9% regularly smoked in the home
19.6% cat in the home
23.6% had a written action plan
58.4% received past asthma education
The RAP group was significantly worse (p>.05) then the control group for impact of asthma, number of physician visits, oral steroid use and smoke in home.
Drop outs appeared to have significantly worse asthma (see separate poster).

Activity limitation improved for both the control and the RAP group

Both groups showed an reducing trend in unscheduled visits to the physician and emergency, and in missed school days.

Appropriate use of medication improved more with the RAP group.

Access to action plans improved for the RAP group in the first 6 months.
The use of peak flow meters statistically increased in the RAP group.
Improvements in avoidance of triggers was significantly different from baseline at both 6 and 12 months in the RAP group.

The RAP group improved in reducing smoking in the home at 6 months
Cats or other animals in the home remained relatively unchanged

Six month improvements were the most dramatic for the RAP group.
Parents of the RAP group indicated a higher level of improvement in their understanding and ability to control and cope with asthma during the intervention phase of the study then the control group.

Sub-groups
The same analysis was done for the following sub groups:
Ages 8-10
>1 unscheduled physician visit
Past asthma education
Non-smokers
Few to no changes in significance was seen.

Discussion

The RAP group showed an overall improvement in outcome measures.
Results suggest that RAP could help reduce health care utilization.
The program generated enormous interest and positive feedback from parents and schools.
Factors that may have influenced the impact of the program include low parent attendance, few physician generated action plans, and mild asthma.
Other outcome measures (quality of life, child behaviour) were assessed but not reported in this poster.

Conclusions

A study of the “Roaring Adventures of Puff” (RAP) asthma education program using randomly selected and assigned schools demonstrated positive outcomes.

Improved outcomes included:
Unscheduled physician visits
Missed schools days
Limitations in kind of play
Frequency in use of bronchodilators
Frequency of medication adjustment
Smoke in the home
Use of peak flow meter
Avoidance of triggers
Perceived ability to control asthma

Acknowledgement

Funded by:

Health Research Fund

Thank you to the Childhood Asthma Foundation for supporting RAP expansion