1. IMPROVING ASTHMA MANAGEMENT IN SCHOOL-AGED CHILDREN USING AN ECOLOGICAL FRAMEWORK Judith Quaranta, PhD, RN, CPN, AE-C, FNAP

2. I have no conflicts to declare

3. Background
8.3% of children have asthma; 53.7% had one or more asthma attacks
Annual per-person medical cost of asthma: $3,266
Asthma 3rd leading cause of hospitalization <15 years
>10 million missed school days each year due to asthma
Barrier for school nurses to provide asthma education is lack of time
Parents have many misperceptions about asthma and lack basic asthma knowledge and asthma management skills, impacting asthma outcomes for their child with asthma.

4. Ecological Approach
McLeroy, Bibeau, Steckler, & Glanz (1988)

5. Open Airways for Schools
American Lung Association school-based asthma education program designed to improve asthma management skills in children with asthma ages 8-11
Usually taught in five to six 50-minute weekly sessions
teaches children to detect warning signs of asthma, to identify and avoid triggers, proper medication administration, and to make decisions about their health.
This program has been approved and recommended by the National Association of School Nurses, honored with a Health Education Research Award from the National Asthma Education and Prevention Program, and is endorsed by the Centers for Disease Control

7. Methods Research Design
A quasi-experimental pretest-posttest design was used. Binghamton University Human Subjects Research Review Committee approved the study.
Participants
convenience sample of children with asthma from local elementary schools (12 groups)

8. Procedure
Nursing students became certified as Open Airways for Schools facilitators through the American Lung Association. School nurses arranged the location and the time to teach. Open Airways was taught at the schools
Parent handouts were sent home after each session.
Pre/posttests for child asthma management skills and parent asthma knowledge were completed prior to the Open Airways program and at completion.

9. Results
99 children with asthma completed the Open Airways for Schools curriculum
4 school districts
9 schools
District 1: 2 elementary schools
Districts 2 and 3: 1 elementary school each
District 4: 5 elementary schools
Ages 6-12 years
60% male, 40% female

10. Results
Paired sample t-tests evaluated the impact of attending Open Airways.
There was a statistically significant increase in asthma self-efficacy scores after attending the program (p <.001).
Specific areas that improved included are on Table 1
No significant difference was found for parents.

12. Conclusion
An ecological approach has been shown to be an effective method to address the need for asthma education for the child with asthma.
Intrapersonal level: this intervention was successful in improving asthma self-efficacy for the children who attend Open Airways
Interpersonal level: Further research needs to be conducted to determine the best way to effect change in parents of children with asthma
Organizational level: Improved access to asthma education
Community level: Partnering with a School of Nursing provides manpower to provide the asthma education and addresses school nurse barrier of lack of time

13. References
Abu-Shaheen, A.K., Nofal, A. & Heena, H. (2016). Parental perceptions and practices toward childhood asthma. BioMed Research International. Retrieved from i/2016/ /abs/
American Lung Association. (2018). Asthma and children fact sheet. Retrieved from
Bhagavatheeswaran, K.S., Kasav, J.B., Singh, A.K., Mohan, S.K., & Joshi, A. (2016). Asthma-related knowledge, attitudes, practices (KAP) of parent of children with bronchial asthma: A hospital-based study. Annals of Tropical Medicine and Public Health [serial online]. Retrieved from
Centers for Disease Control and Prevention. (2018). Most recent asthma data. Retrieved from
McLeroy, K., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15 (4),
Nurmagambetov ,T., Kuwahara, R., &Garbe, P. (2018). The economic burden of asthma in the United States: Annals of the American Thoracic Society, 15(3). Retrieved from
Pappalardo, A.A., Paulson, A., Bruscato, R., Thomas, L., Minier, M., & Martin, M.A. (2019). Chicago public school nurses examine barriers to school asthma care coordination. Public Health Nursing, 36(1),
Quaranta, J.E., & Spencer, G.A. (2016). Barriers to asthma management as identified by school nurses. The Journal of School Nursing, 32(5), doi: /