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

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

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

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

La formation à l’enseignement dans une communauté enseignante. Les Frères des écoles chrétiennes du Québec 1837–1980

RÉSUMÉ Fondée en France à la n du 17e siècle pour l’instruction des garçons des classes laborieuses vivant en milieu urbain, la communauté des Frères des écoles s’implante au Québec à l’automne 1837 avec l’ouverture d’une première école. Héritière d’une longue tradition pédagogique, elle implante ici l’usage de l’enseignement simultané auquel elle joint quelques pratiques de l’enseignement mutuel déjà pratiqué au Québec. Pour contrer l’absence de toute école normale, elle commence par former ses propres recrues pour ensuite offrir le même service aux professeurs laïcs de même qu’à des communautés de sœurs enseignantes sans tradition dans l’enseignement. À partir du début de la décennie 1920, la communauté adopte les programmes des écoles normales gérées par le Département de l’instruction permettant ainsi aux religieux de se munir des mêmes diplômes d’enseignement que les instituteurs laïcs. En n, les frères se perfectionnent dans les rares structures universitaires dispensant des cours de pédagogie avant de fonder leur propre institut universitaire, l’Institut pédagogique Saint-Georges. Cette étude aborde, dans un premier temps, les structures dans lesquelles s’est enseignée la pédagogie chez les frères des écoles chrétiennes du Québec. La description du cadre dans lequel elle s’est enseignée devrait servir de préliminaire à une analyse du discours sur la pédagogie tel qu’exprimé dans les écrits de la communauté. ABSTRACT Founded in France at the end of the seventeenth century for the education of boys from the urban working-class, the Brothers of the Christian Schools—les frères des écoles chrétiennes—opened their rst school in Québec in the autumn of 1837. Drawing on a long teaching tradition, the order was responsible for introducing the use of simultaneous instruction, which they blended with certain techniques of mutual instruction already being employed in Québec. To make up for the absence of a normal school, the Brothers trained their own instructors; they would later offer the same service to lay educators and those orders of teaching sisters without a tradition of teacher instruction. Beginning in the early 1920s, the order adopted the curriculum used in the normal schools run by the Department of Education, thereby permitting religious educators to obtain the same teaching diplomas as lay instructors. Finally, after studying at the few university institutions that offered courses in pedagogy, the Brothers founded their own, l’Institut pédagogique Saint-Georges. This study examines, first of all, the structures within which the Brothers of the Christian Schools taught educational methods. A description of this organizational framework should serve as an introduction to the discourse on pedagogy as expressed in the writings of the community.

Pilot Test of a Peer-Led Small-Group Video Intervention to Promote Mammography Screening Among Chinese American Immigrants

This study evaluated the feasibility, acceptability, and potential effect of a small-group video intervention led by trained Chinese American lay educators who recruited Chinese American women not up to date on mammography screening. Nine lay educators conducted 14 Breast Health Tea Time Workshops in community settings and private homes that started with watching a culturally tailored video promoting screening followed by a question-and-answer session and distribution of print materials. Many group attendees did not have health insurance or a regular doctor, had low levels of income, and were not proficient in English. Forty-four percent of the attendees reported receipt of a mammogram within 6 months after the small-group session, with higher odds of screening among women who had lived in the United States less than 10% of their lifetime. Four of the educators were very interested in conducting another group session in the next 6 months.