scholarly journals Task-shifting to Improve Asthma Education for Malawian Children: a Qualitative Analysis

2020 ◽  
Author(s):  
Lovemore Nkhalamba ◽  
Sarah Rylance ◽  
Adamson S. Muula ◽  
Kevin Mortimer ◽  
Felix Limbani
Keyword(s):  
Controlled Trial ◽  
Asthma Management ◽  
Task Shifting ◽  
Clinical Staff ◽  
Health Coverage ◽  
Clinical Environment ◽  
Asthma Care ◽  
Asthma Education ◽  
Senior Nurse ◽  
Lay Educators

Abstract Background:Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.Methods:We conducted 6 focus group discussions, including 15 children and 28 carers, and individual interviews with 4 lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified. Results:Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, , and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approachDiscussion:Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.Trial Registration:The RCT was registered in the Pan African Clinical Trials Registry: PACTR201807211617031

scholarly journals Task-shifting to improve asthma education for Malawian children: a qualitative analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lovemore Nkhalamba ◽  
Sarah Rylance ◽  
Adamson S. Muula ◽  
Kevin Mortimer ◽  
Felix Limbani
Keyword(s):  
Controlled Trial ◽  
Asthma Management ◽  
Task Shifting ◽  
Clinical Staff ◽  
Health Coverage ◽  
Clinical Environment ◽  
Asthma Care ◽  
Asthma Education ◽  
Senior Nurse ◽  
Lay Educators

Abstract Background Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention. Methods We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified. Results Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach. Discussion Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage. Trial registration The RCT was registered in the Pan African Clinical Trials Registry: PACTR201807211617031

scholarly journals An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216065 ◽  
Author(s):  
Sarah Rylance ◽  
Beatrice Chinoko ◽  
Bright Mnesa ◽  
Chris Jewell ◽  
Jonathan Grigg ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Low Income ◽  
Standard Care ◽  
Controlled Trial ◽  
Scale Up ◽  
Asthma Management ◽  
Control Group ◽  
Asthma Care ◽  
Care Package ◽  
Randomised Controlled

BackgroundShortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles.MethodsWe conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6–15 years diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3 months. Secondary outcomes included asthma exacerbations requiring emergency healthcare and school absence.FindingsBetween September 2018 and December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3 months, intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared with standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1 to 3.1, p<0.001). Fewer intervention children attended emergency healthcare (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001) compared with standard care children.InterpretationThe intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings.Trial registration numberPACTR201807211617031.

Feasibility study of a communication and education asthma intervention for general practitioners in Australia

2010 ◽  
Vol 16 (1) ◽  
pp. 75 ◽  
Author(s):  
Smita Shah ◽  
Brett G. Toelle ◽  
Susan M. Sawyer ◽  
Jessica K. Roydhouse ◽  
Peter Edwards ◽  
...  
Keyword(s):  
General Practitioners ◽  
Controlled Trial ◽  
Communication Strategies ◽  
Asthma Management ◽  
Doctor Patient Communication ◽  
Children With Asthma ◽  
The Usa ◽  
Randomised Controlled ◽  
Communication Behaviours ◽  
The Impact

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.

A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice

2011 ◽  
Vol 17 (3) ◽  
pp. 288 ◽  
Author(s):  
Jessica A. Roydhouse ◽  
Smita Shah ◽  
Brett G. Toelle ◽  
Susan M. Sawyer ◽  
Craig M. Mellis ◽  
...  
Keyword(s):  
General Practitioners ◽  
Management Practices ◽  
Inhaled Corticosteroids ◽  
Management Practice ◽  
Controlled Trial ◽  
Asthma Management ◽  
Convenience Sample ◽  
Paediatric Asthma ◽  
Baseline Questionnaire ◽  
Practitioner Attitudes

The prevalence of asthma in Australia is high. Previous findings have suggested that asthma management, particularly in primary care, remains suboptimal and recent government initiatives to improve asthma management and encourage the use of written asthma action plans (WAAPs) in general practice have been implemented. We aimed to assess the attitudes, confidence and self-reported paediatric asthma management practices of a convenience sample of Australian general practitioners (GPs). A baseline questionnaire was administered to GPs as part of a randomised controlled trial. General practitioners (GPs) were recruited from two areas of greater metropolitan Sydney, NSW between 2006 and 2008. Invitations were sent to an estimated 1200 potentially eligible GPs. Of 150 (12.5%) GPs that enrolled, 122 (10.2%) completed the baseline questionnaire. Though 89% were aware of the Australian National Asthma Guidelines, less than 40% were familiar with guideline recommendations. While 85.2% had positive attitudes towards WAAPs, only 45.1% reported providing them frequently. For children with frequent symptoms, 90% agreed they should prescribe daily, inhaled corticosteroids (ICS), and 83% reported currently prescribing ICS to such patients. These findings indicate gaps between GP attitudes and behaviours and highlights opportunities for interventions to improve paediatric asthma management.

A nurse-led web-based home asthma education program for children and their families: A randomized controlled trial

2021 ◽  
Vol 59 ◽  
pp. 158-163
Author(s):  
Juliet S.K. Ng ◽  
Janita P.C. Chau ◽  
Aileen W.K. Chan ◽  
Jacky K.C. Lui ◽  
James W.C.H. Cheng
Keyword(s):  
Randomized Controlled Trial ◽  
Education Program ◽  
Controlled Trial ◽  
Asthma Education ◽  
Web Based ◽  
Randomized Controlled

scholarly journals Patient satisfaction with task shifting of antiretroviral services in Ethiopia: implications for universal health coverage

2014 ◽  
Vol 29 (suppl 2) ◽  
pp. ii50-ii58 ◽  
Author(s):  
E. Asfaw ◽  
S. Dominis ◽  
J. G. H. Palen ◽  
W. Wong ◽  
A. Bekele ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Universal Health Coverage ◽  
Task Shifting ◽  
Health Coverage ◽  
Universal Health

Assessing the efficacy of photocatalytic oxidation on bacterial contamination in a clinical setting – a randomised controlled trial

2011 ◽  
Vol 12 (6) ◽  
pp. 251-253
Author(s):  
Anwar Abbas Jafri ◽  
Sanjay Gupta ◽  
Zaki Ibrahim ◽  
Paul Baker ◽  
Tamsin Oswald ◽  
...  
Keyword(s):  
Clinical Setting ◽  
Photocatalytic Oxidation ◽  
Controlled Trial ◽  
Colony Count ◽  
Clinical Environment ◽  
Randomised Study ◽  
Air Contamination ◽  
Air Sampler ◽  
Airborne Contamination ◽  
Air Purifier

Airborne contamination has been shown to be a significant source of wound contamination in orthopaedic surgery. This is the first reported study looking at the efficacy of ActivTek 300, a portable UV/TiO2-based air purifier unit to reduce airborne contamination in a clinical setting. In this randomised study the investigator was blinded as to whether the unit had been on or off for the previous seven days. Air contamination was measured weekly using a validated technique in ward treatment rooms using a Mini Air Sampler (MAS-100) and agar plates, over a period of 12 weeks. The agar plates were then incubated for 24 hours and the results were expressed as number of colony forming units per plate (cfu). The biomedical scientist who manually counted the number of cfus was blinded as to whether the unit was on or off. Measurements were duplicated to improve the accuracy of the study, and in addition to this an identical experiment was set up in a second treatment room on a separate randomisation schedule. Analysis of the data demonstrated median colony count was significantly lower with the unit on (Median = 43 interquartile range (IQR) 30 to 83) than when it was off (median = 95 IQR 44 to 143) ( p < 0.01). This represents a 55% mean reduction in the colony count. This study suggests that the portable UV/TiO2-based air purifier unit is efficacious in reducing airborne contamination in the clinical environment and may have a promising role in reducing overall infection rates in surgical patients.

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