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Children and adolescents with asthma, ages 9–14 years, experience increased morbidity and mortality over all other age groups across the lifespan (Akinbami, 2006; Akinbami, Moorman, & Liu, 2011; Mannino et al., 2002). They are admitted to hospitals in life-threatening situations, restricted from participating in normal life activities, and absent from school more than their peers. These adverse outcomes are often attributed to poor self-management. Nursing care outcome criteria for children with asthma have long specified that pulmonary function will be promoted with responsibility for self-care assumed (Larter, Kieckhefer, & Paeth, 1993). While some healthcare professionals assume that older school-age children and early adolescents, hereafter referred to as students, are unable or unwilling to accept responsibility for managing their condition, most healthcare providers realize that asthma is multi-factorial with individual, disease, and environmental factors that affect how well the condition is controlled. Older school-age students and early adolescents with asthma have stated and demonstrated that accepting asthma as a chronic condition is especially difficult as they transition from elementary to middle or junior high school (Kintner, 1997, 2004, 2007; Kintner et al., 2012; Kintner & Sikorskii, 2009). Many of the issues they encounter are associated with school situations and activities. Students report experiencing a barrage of negative emotions, facing numerous psychosocial challenges, worrying about the stigmatization of the condition, feeling embarrassed by symptoms and taking medications in public, needing help with decision-making, and struggling in situations where the symptoms and treatments conflict with the normative behavior of healthy peers (Edgecombe, Latter, Peters, & Roberts, 2010; Kintner, 2004, 2007; Rhee, Belyea, & Brasch, 2010; Stewart, Masuda, Letourneau, Anderson, & McGhan, 2011; Tibosch et al., 2010). Strong anecdotal evidence points to life-threatening situations in schools resulting from students not complying with treatment protocols for reasons such as embarrassment or taunting from peers, non-cooperation or policy-based restrictions of school personnel, or age-appropriate risk-taking behavior of students. Interdisciplinary, comprehensive, developmentally-appropriate, school-based asthma health education and counseling programs for older school-age students are needed that address the multiple factors affecting cognitive, psychosocial, and behavioral outcomes that impact condition severity, quality of life, and use of healthcare services (National Institutes of Health [NIH], 2007). A school-based, theory-driven, and evidence-guided academic health education and counseling program was developed by nurse specialists in pediatric asthma, school/family health care, and psychiatric/mental health counseling working in collaboration with other healthcare professionals and school personnel. The program, Staying Healthy–Asthma Responsible & Prepared™ (SHARP), was designed to foster acceptance of asthma by addressing cognitive, psychosocial, and behavioral aspects of condition management that impact condition severity, use of healthcare systems, and quality of life outcomes (Kintner et al., 2012; Kintner & Sikorskii, 2009). In addition, SHARP was designed to integrate into schools in such a way that it would be more likely to be embraced by schools pressured to demonstrate academic outcomes. SHARP targets older school-age students on the cusp of growth trajectories for shifting away from parental to more personal responsibility for managing their condition as they transition from elementary to middle or junior high school. Feasibility, benefits, and efficacy of SHARP are established. Students in grades 6 to 7 with asthma, their caregivers, school personnel, and community partners were interviewed and completed satisfaction surveys to establish SHARP’s feasibility (Kintner et al., 2012). A single-group, pre-post and 12-month follow-up study confirmed SHARP’s benefits using students in grades 6–7 with asthma on cognitive, psychosocial, behavior, and quality of life outcomes (Kintner et al., 2012). Efficacy of SHARP was established using a two-group, pretest–posttest, randomized clinical trial with treatment and usual care control groups of students in grades 4–6 with asthma (Kintner & Sikorskii, 2009). This paper presents results of a phase III randomized clinical trial conducted to evaluate the effectiveness and impact of SHARP on cognitive, psychosocial, and behavioral factors that impact asthma severity/control, use of healthcare services, and quality-of-life outcomes including school attendance/absenteeism. The age range for this study was determined by the grade at which students in the target school district transition into middle school. Students transitioned into middle school in the sixth grade; therefore, students with asthma enrolled in the fourth and fifth grades were invited to participate. Cognitive, behavior, quality of life, asthma severity/control, quality of life, and use of healthcare services outcomes are reported elsewhere. Purpose The purpose of this paper is to report the effectiveness of SHARP on fostering psychosocial acceptance of asthma in fourth- and fifth-grade students with asthma at 1, 12, and 24 months post-intervention. When evaluating effectiveness, students enrolled in the academic health education and counseling program being evaluated are compared to students enrolled in an attention-control or condition-control program. Because all students enrolled in the study were diagnosed with asthma, we elected to use a well-established, non-academic asthma health education and counseling program for comparison. We hypothesized that compared to students enrolled in elementary schools who received a condition-control program; students in elementary schools that received SHARP would demonstrate equivalent or increased psychosocial acceptance of asthma. Students randomized to the condition-control group received the non-academic asthma health education and counseling program Open Airways for Schools (Clark et al., 2004), a curriculum that is disseminated through the American Lung Association. |
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