An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: a randomised controlled trial.

OBJECTIVE: To assess the outcomes of an education intervention for childhood asthma conducted by Australian Indigenous health care workers (IHCWs). DESIGN AND SETTING: Randomised controlled trial in a primary health care setting on Thursday Island and Horn Island, and in Bamaga, Torres Strait region of northern Australia, April 2005 to March 2007. PARTICIPANTS: 88 children, aged 1-17 years, with asthma diagnosed by a respiratory physician (intervention group, 35; control group, 53; 98% Indigenous children). INTERVENTIONS: Children were randomly allocated to: (i) three additional asthma education sessions with a trained IHCW, or (ii) no additional asthma education. Both groups were re-assessed at 12 months. MAIN OUTCOME MEASURES: Primary endpoint: number of unscheduled visits to hospital or a doctor caused by asthma exacerbation. SECONDARY OUTCOMES: measures of quality of life (QoL) and functional severity index; asthma knowledge and understanding of asthma action plans (AAPs); and school days missed because of wheezing. RESULTS: The groups were comparable at baseline (except for asthma severity, which was adjusted for in the analysis). There were no significant differences in the primary outcome (number of unscheduled medical visits for asthma). School children in the intervention group missed fewer school days because of wheezing (100% < 7 days v 21% of those in the control group missed 7-14 days). Significantly more carers in the intervention group could answer questions about asthma medication, knew where their AAP was kept (84% v 56%), and were able to describe the plan (67% v 40%). In both the intervention and control groups (before-and-after comparison), there was a significantly reduced frequency of asthma exacerbations, as well as an improved QoL score and functional severity index, with no significant differences between the groups. CONCLUSIONS: A community-based asthma education program conducted by trained IHCWs improves some important asthma outcomes in Indigenous children with asthma. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012605000718640.

Indigenous healthcare worker involvement for Indigenous adults and children with asthma.

BACKGROUND: Asthma education is regarded as an important step in the management of asthma in national guidelines. Racial, ethnicity and socio-economic factors are associated with markers of asthma severity, including recurrent acute presentations to emergency health facilities. Worldwide, indigenous groups are disproportionately represented in the severe end of the asthma spectrum. Appropriate models of care are important in the successful delivery of services, and are likely contributors to improved outcomes for people with asthma. OBJECTIVES: To determine whether involvement of an indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programs, improves asthma related outcomes in indigenous children and adults with asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles. The latest search was in January 2010. SELECTION CRITERIA: All randomised controlled trials comparing involvement of an indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programs for indigenous people with asthma. DATA COLLECTION AND ANALYSIS: Two independent review authors selected data for inclusion, a single author extracted the data. Both review authors independently assessed study quality. We contacted authors for further information. As it was not possible to analyse data as "intention-to-treat", we analysed data as "treatment received". MAIN RESULTS: Two studies fulfilled inclusion criteria involving 133 children randomised to an asthma education programme involving an IHW, compared to a similar education programme without an IHW. One study was not strictly Indigenous. 110 of these children completed the trials. Children's asthma knowledge score was significantly better in the group that had IHW education compared with control (mean difference 3.30; 95% CI 1.07 to 5.53), parents' asthma knowledge score (standardised mean difference (SMD) 1.23; 95% CI 0.59 to 1.87), parents' asthma skill score (SMD 0.67; 95% CI 0.28 to 1.06) and days absent from school (100% school-aged children in the intervention group missed <7 days, 21% of controls missed 7-14 days, difference = 21%, 95%CI 5-36%). There was no significant difference in mean number of exacerbations (per year) between groups. There was no difference in quality of life or children's asthma skill score; both were limited to one study only and the direction favoured IHW group. There were no studies in adults. AUTHORS' CONCLUSIONS: The involvement of IHW in asthma programs targeted for their own ethnic group in 2 small trials was beneficial in improving most, but not all asthma outcomes in children with asthma. It is very likely that involvement of an IHW is beneficial. However as exacerbation frequency was not significantly different between groups, we cannot be confident of the results in all settings. Nevertheless, given the complexity of health outcomes and culture as well as the importance of self-determination for indigenous peoples, the practice of including IHW in asthma education programs for indigenous children and adults with asthma is justified, but should be subject to further randomised controlled trials.

Stable prevalence of asthma symptoms in school-aged children in the Torres Strait region.

BACKGROUND AND OBJECTIVE: To (i) determine if the prevalence of asthma has altered in two previously studied communities and (ii) obtain baseline measures in two further communities in the Torres Strait region, Australia. METHODS: A population-based cross-sectional study of school-aged children was conducted. Five schools in four communities were selected: 361 children aged 5-17 years participated. The study used the same epidemiological tool that had been utilized to measure asthma prevalence (locally adapted International Study of Asthma and Allergy in Childhood questionnaire). RESULTS: The overall response rate was 30%; response rates in individual communities ranged from 23% to 100%. The prevalence of self-reported wheezing in the last 12 months decreased from 10.7% to 6.6% (P = 0.109) on Thursday Island and from 3.1% to zero (P = 0.358) on Warraber Island. The percentage of children with asthma symptoms was lower in this current study but changes were not statistically significant. Overall self-reported prevalence of ever wheezing was 12.5%; 5.4% reported wheezing in the previous 12 months, 5.9% reported wheezing after exercise and 12.2% reported ever having asthma. There was considerable inter-community variation in the prevalence of symptoms. CONCLUSIONS: Asthma prevalence in school-aged children living in the Torres Strait region remains high but, as in mainstream Australian children, the prevalence is stable.