Culture-Specific Asthma Education Could Improve Quality Of Life

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Asthma education programs tailored specifically for ethnic minority groups can help improve asthma sufferers' knowledge of their condition and their quality of life, suggests a new review.

However, even considering the new review's findings, it is still "difficult to predict what will be successful in improving the occurrence of asthma exacerbations," said lead author Emily Bailey. "However, we would be hopeful that with increased knowledge, people would be able to better manage their asthma and this would perhaps have an effect on the incidence of asthma exacerbations."

Bailey is with the child health division of the Menzies School of Health Research in Queensland, Australia

Asthma is one of the leading chronic diseases worldwide and affects about 20 million people in the United States, according to the Centers for Disease Control and Prevention. It is accountable for nearly 2 million visits to U.S. emergency rooms each year.

Various programs exist to educate people with asthma, and asthma education can be critical in helping to improve these patients' management of their disease. Past research has shown, however, that minorities with asthma suffer from poorer health outcomes and have more asthma-related visits to hospital emergency rooms each year.

Therefore, researchers have wondered if improvements to asthma education would help reach more minorities and decrease their number of severe asthma occurrences and hospital visits. The systematic review aimed to determine whether culture-specific asthma programs could better improve asthma outcomes in children and adults compared to generic education programs.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

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Bailey and colleagues evaluated three studies that included 396 people with asthma from ethnic minority groups. Participants were between the ages of 7 and 59. Each trial compared the use of culture-specific asthma education programs to generic education programs or usual care.

For instance, one study enrolled 28 African-American adults with asthma. Participants in the intervention group received three one-hour individual asthma self-management sessions that included the use of a workbook modified to be specific to African-Americans. Those in the group also watched a video on how properly to use a metered dose inhaler and peak flow meter featuring a well-known African-American asthma specialist.

The researchers followed up with the participants at three and six months after the study. Those who were in the intervention group had an average asthma quality of life score of 4.59 points, compared with an average score of 4.43 points from participants in the control group.

The Cochrane reviewers found that the culture-specific programs in all three studies were "superior to generic programs or usual care" in improving asthma quality of life scores in adults. Groups receiving the culture-specific programs had higher scores compared to the controls, with an average difference of a quarter-point higher score. The programs also improved asthma knowledge scores in children, by an average of a 3.3 points higher score.

Bailey and her colleagues were unable to conclude whether the culture-specific programs had any influence on asthma hospitalizations because of the small number of available studies as well as insufficient data from each study.

Bailey said that more research in the area of culture-specific asthma programs will help answer this question, but acknowledge that cost is a factor.

"A lot of work has been published regarding asthma education for minority groups, however, not using a program that is culture-specific," said Bailey. "Culture-specific programs are more expensive than generic programs and this may be a prohibitive factor."

Daphne Koinis Mitchell, Ph.D., an assistant professor at Brown Medical School, has done research in the area and said that, indeed, few programs incorporate teaching minority patients the standards of asthma care along with addressing their cultural needs.

"Most asthma programs available to ethnic minority families are asthma educational programs that may be bilingual in nature," Koinis Mitchell said. "However, more programs that incorporate cultural belief systems about health and illness, as well as specific concerns that may serve as barriers to optimal control, are needed."

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