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Meta-Analysis
. 2011 Oct 5;2011(10):CD008469.
doi: 10.1002/14651858.CD008469.pub2.

Home-based educational interventions for children with asthma

Emma J Welsh  1 , Maryam Hasan, Patricia Li
Affiliations
Meta-Analysis

Home-based educational interventions for children with asthma

Emma J Welsh et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: While guidelines recommend that children with asthma should receive asthma education, it is not known if education delivered in the home is superior to usual care or the same education delivered elsewhere. The home setting allows educators to reach populations (such as the economically disadvantaged) that may experience barriers to care (such as lack of transportation) within a familiar environment.

Objectives: To perform a systematic review on educational interventions for asthma delivered in the home to children, caregivers or both, and to determine the effects of such interventions on asthma-related health outcomes. We also planned to make the education interventions accessible to readers by summarising the content and components.

Search strategy: We searched the Cochrane Airways Group Specialised Register of trials, which includes the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED and PsycINFO, and handsearched respiratory journals and meeting abstracts. We also searched the Education Resources Information Center database (ERIC), reference lists of trials and review articles (last search January 2011).

Selection criteria: We included randomised controlled trials of asthma education delivered in the home to children, their caregivers or both. In the first comparison, eligible control groups were provided usual care or the same education delivered outside of the home. For the second comparison, control groups received a less intensive educational intervention delivered in the home.

Data collection and analysis: Two authors independently selected the trials, assessed trial quality and extracted the data. We contacted study authors for additional information. We pooled dichotomous data with fixed-effect odds ratio and continuous data with mean difference (MD) using a fixed-effect where possible.

Main results: A total of 12 studies involving 2342 children were included. Eleven out of 12 trials were conducted in North America, within urban or suburban settings involving vulnerable populations. The studies were overall of good methodological quality. They differed markedly in terms of age, severity of asthma, context and content of the educational intervention leading to substantial clinical heterogeneity. Due to this clinical heterogeneity, we did not pool results for our primary outcome, the number of patients with exacerbations requiring emergency department (ED) visit. The mean number of exacerbations requiring ED visits per person at six months was not significantly different between the home-based intervention and control groups (N = 2 studies; MD 0.04; 95% confidence interval (CI) -0.20 to 0.27). Only one trial contributed to our other primary outcome, exacerbations requiring a course of oral corticosteroids. Hospital admissions also demonstrated wide variation between trials with significant changes in some trials in both directions. Quality of life improved in both education and control groups over time.A table summarising some of the key components of the education programmes is included in the review.

Authors' conclusions: We found inconsistent evidence for home-based asthma educational interventions compared to standard care, education delivered outside of the home or a less intensive educational intervention delivered at home. Although education remains a key component of managing asthma in children, advocated in numerous guidelines, this review does not contribute further information on the fundamental content and optimum setting for such educational interventions.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Education versus control, Outcome 1 Exacerbations leading to emergency department visits.
1.2
1.2. Analysis
Comparison 1 Education versus control, Outcome 2 Mean exacerbations resulting in ED visits.
1.3
1.3. Analysis
Comparison 1 Education versus control, Outcome 3 Mean exacerbations requiring a course of oral corticosteroids.
1.4
1.4. Analysis
Comparison 1 Education versus control, Outcome 4 Days missed from school or work.
1.5
1.5. Analysis
Comparison 1 Education versus control, Outcome 5 Exacerbations leading to hospitalisation.
1.6
1.6. Analysis
Comparison 1 Education versus control, Outcome 6 Mean exacerbations leading to hospitalisation.
2.1
2.1. Analysis
Comparison 2 Education versus other home‐based education, Outcome 1 Exacerbations leading to ED visits.
2.2
2.2. Analysis
Comparison 2 Education versus other home‐based education, Outcome 2 Mean exacerbations requiring a course of oral corticosteroids.
2.3
2.3. Analysis
Comparison 2 Education versus other home‐based education, Outcome 3 Exacerbations leading to hospitalisation.
2.4
2.4. Analysis
Comparison 2 Education versus other home‐based education, Outcome 4 Mean hospital admissions.
See this image and copyright information in PMC

References

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van Es 2001 {published data only}
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Vazquez 1993 {published data only}
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Walders 2006 {published data only}
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Warschburger 2003 {published data only}
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Wensley 2001 {published data only}
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Williams 2006 {published data only}
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    1. Shanovich KK, Pulvermacher AD, Hollman SJ, Richardson PA, Wise ME, Lee SH, et al. Nurse case management services provided to supplement a web‐based asthma education program. Journal of Allergy and Clinical Immunology. 2008; Vol. 121(2 Suppl 1):S40 [155].
    1. Wise M, Gustafson DH, Sorkness CA, Molfenter T, Staresinic A, Meis T, et al. Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a web‐based asthma education program. Health Promotion Practice 2007;8(3):282‐91. - PMC - PubMed
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Zhao 2005 {published data only}
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Zorc 2005 {published data only}
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References to studies awaiting assessment

Adams 2004 {published data only}
    1. Adams CD. Parent‐youth teamwork in pediatric asthma management. NCT00166582 2005.
    1. Adams CD, Joseph KE, MacLaren JE, DeMore M, Koven L, Detweiler MF, et al. Parent‐youth teamwork in pediatric asthma management. Journal of Allergy and Clinical Immunology 2004;113(Suppl 2):S159.
Boone 2002 {published data only}
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Cameron 1989 {published data only}
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Kelly 2005 {published data only}
    1. Kelly CS, Taylor‐Fishwick JC, Harrison L, Collins‐Odoms C, Hixson J. EZ breathers: a partnership to improve asthma management using a combination of staff education and home visits in a Head Start population. Journal of Allergy and Clinical Immunology 2005;115(Suppl 2):S63.
Mishra 2005 {published data only}
    1. Mishra N, Rao KVR, Padhi SK. Asthma education for better compliance in disease management. Indian Journal of Allergy Asthma & Immunology 2005;19(1):25‐8.
Rand 2004 {published data only}
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Taylor‐Fishwick 2005 {published data only}
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Yang 2005 {published data only}
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References to ongoing studies

Rand 2006 {published data only}
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