Randomized clinical trial of a school-based academic and counseling program for older school-age students.

摘要

BACKGROUND: Up to 17% of children in the United States have been diagnosed with asthma; children ages 9-14 years experience higher morbidity and mortality compared with other age groups. An academic and counseling program for older elementary students with asthma was developed in collaboration with school personnel, healthcare professionals, and community members: Staying Healthy-Asthma Responsible and Prepared (SHARP). The life span development perspective and the Acceptance of Asthma Model were used to guide development and implementation. OBJECTIVES: This study aimed to establish the preliminary efficacy of SHARP to improve cognitive, behavioral, psychosocial, and quality-of-life outcomes. METHODS: A two-group, longitudinal, prospective, cluster randomized clinical trial design was used. The sample of fourth- to sixth-grade students (N = 66) with asthma aged 9-12 years (M = 10.5, SD = 0.9) was 52% male, was racially diverse (30% Black, 36% White, and 18% biracial), and had a wide range of incomes. Three schools (n = 38 students) were randomized to receive SHARP, and two schools (n = 28 students) were assigned to usual care. Self-report instruments were used. RESULTS: Compared with the usual care group, statistically significant improvements in the SHARP group were found in student knowledge of asthma, reasoning about asthma, use of risk reduction behaviors, and participation in life activities (p < .01, effect sizes >0.7). Improvements in use of episode management behaviors and acceptance of asthma outcomes were clinically significant with medium effect sizes of 0.3-0.5. DISCUSSION: The SHARP Student and Community Components demonstrated preliminary efficacy for improving asthma knowledge, reasoning about asthma, use of episode management and risk reduction behaviors, acceptance of asthma in taking control and vigilance, and participation in life activities.