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Which educational strategies work?

Angela Boque (Spain):

The main strategies we use are to talk and talk and answer and listen and talk and answer and listen and talk and answer. I think this is very important. The ideal strategy probably would be to get together groups of patients of the same age and groups of parents of the same status and age, that would be of great help. But we cannot do this at the moment in our public health system.

Len Fromer (USA):

We try to make sure that 100% of the kids with asthma have an individualized written treatment plan. We use a template, which makes the process easier. For kids we use the green zone, yellow zone, red zone Asthma Action Plan that is based on symptoms, rescue medication use, and peak flow measurements. We give them trending sheets, which are forms on which they can record their peak flow readings, and we ask them to bring the trending sheets to their appointments, so the doctor can look them over and see their status at a glance. Moreover, the trending sheets empower and motivate the kids because we ask them to fill them out themselves. We believe in actively involving the patient and family in the treatment plan and soliciting their feedback on the care they're receiving.

Svein Høegh Henrichsen (Norway):

I think one has to explain the nature of the disease, that there is an underlying inflammation, that there are chronic changes, and that the treatment is to treat the inflammation, to reduce it; also to explain how the medication works. And to discuss triggers and what to do to avoid triggers. First of all, you have to find out what triggers the asthma and to discuss how they might avoid them. The main thing I think is to motivate children to take their medication regularly, which is the biggest problem actually.

Chris Hogan (Australia):

What I believe is that the effective strategy is to have multiple strategies. First of all there needs to be provision of basic information in a way that people can understand it. People then need to be educated, in other words they need to have assistance and support to integrate the new information. Education is more than the simple provision of information. Education is the integration of new information into a person's pre-existing beliefs and understandings. We need to operate off a system of narrative, and there needs to be a consistent message delivered by all health professionals.

Alan Kaplan (Canada):

The strategies they can understand. In the best world, the teacher would be someone with a good knowledge base who is able to impart that education to a family or family member. That would be the right person. Sometimes that's going to be the family physician, sometimes it's going to be an educator, someone working in an asthma centre. Sometimes no matter what you tell people, they're not going to listen. The classic example is the teenager; having someone who can relate to him or her is going to be the important thing.

Sarath Paranavitane (Sri Lanka):

One-to-one conversation, explaining to parents and children. One problem with the printed material is that it's mostly in English, and very few in Sri Lanka are able to read and comprehend. So the best way is to verbally explain to them, one-to-one.

Dermot Ryan (UK):

Telling the patients about what the disease is and what the medications are for. Telling them that the important thing is that by taking the medications, they can control the disease and lead a completely normal life. So I think stressing the normality of asthma rather than the downside, stressing the importance equally of taking the medication on a regular basis in order to control the problem. We seem to get through to the vast majority of patients. But different people want to hear different things, so you really have to adapt and change according to the individual's needs, individual circumstances.

Björn Ställberg (Sweden):

With asthma patients it's important to individualize education. It depends on what the problems are. Perhaps the patient is a 16-year-old boy who wants to play a sport or a 16-year-old girl who loves her cat. It's important to give a simple and short written treatment plan; I usually write a small note. I suspect that adult patients seldom read my notes, but parents of small children will post the paper in the kitchen somewhere. When you have small children you do everything for them. In fact, sometimes the problem for small children is that parents give them too much medication; they're too afraid about asthma. And of course we use small brochures and booklets. Many young people today go to the computer, the Internet. Finally, I think it's very important to talk about the treatment goals: 1. symptom free, 2. no need of rescue medication, and 3. no exercise-induced problems. So they know that if they don't reach the treatment goals they have to come back and we have to change medication. Also it's important to keep the messages consistent from doctor, nurses, pharmacists.

Osman Yusuf (Pakistan):

Everything, any educational strategy which is going to target the parents and children. What we are doing includes cartoon books in schools, leaflets in public for increasing the awareness of parents about children's asthma. Increasing the level of education for doctors to be able to diagnose it more. The biggest impact I would say is from television. Because every time I'm on television, I receive at least 20 to 30 telephone calls the same day or the day after. The biggest impact we've had is with television talk shows, television interviews, talking to people about asthma. That's what we're doing for World Asthma Day this year: a massive media show in one of the hospitals here where patients are going to come and listen to other patients. It's going to be televised as well as on the radio for people to call in and discuss, as well as for other patients to say, "Look, we are taking inhalers and this is how our lives have improved." I have done two or three programs, not televised, however, for an organization called Mothers' Network of Asthmatic Children in Dubai, where we invite mothers at random to come and ask all the questions they want about asthma and allergy for their children, about management of asthma. And that seems to work well: they feel they're getting free advice, they come with prepared questions, they're open and relaxed, they cross-question. Also I've done a couple of programs about children with allergy and asthma as part of an English-speaking talk show on ARY digital channel, which is televised from Dubai and broadcast all over the world for Pakistani and Indian populations; it's a Hindi-English channel. And on that mothers can call in live and ask questions and get a reply. It's widely watched; I get calls from all over the world. People ask, "Where do we go for advice?" That's a common question.