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* From the Global Health Leadership Office (Dr. McElmurry), College of Nursing (Mr. Buseh), and Chicago Health Corps (Ms. Dublin), College of Nursing, University of Illinois at Chicago, Chicago, IL. Supported by a grant from the Otho S.A. Sprague Memorial Institute to the Chicago Health Corps, Inc.
Correspondence to: Beverly McElmurry, EdD, RN, FAAN, Professor and Associate Dean, Global Health Leadership Office (M/C 802), College of Nursing, University of Illinois at Chicago, 845 S Damen Ave, Room 1160, Chicago, IL 60612-7350; e-mail: mcelmurr{at}uic.edu
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Introduction |
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The Chicago Health Corps (CHC) asthma program offers an alternative approach to patient education based on a modification of the American Lung Association's Open Airways Program. The CHC program provides school-based education for students and parents/guardians to increase their knowledge, motivation, and skills in order to prevent and control asthma symptoms and minimize the adverse impact of illness. At the same time, CHC members have an opportunity to develop and promote voluntary service in their local communities. The history and activities of the CHC (an Americorps program) have been described elsewhere.1
Two formal training sessions on issues related to asthma control were conducted to prepare the CHC members to implement the Open Airways program at selected schools in the Chicago Public Schools (CPS) system. Once trained, CHC members were teamed in pairs and assigned to specific schools. Each team presented the program (six lessons, 45 min per lesson) at a day and time identified by the school nurse/principal to groups ranging from five to 15 students at any one school.
During a 3-year period, 25 CHC members were trained in asthma management. They taught 164 students drawn from 11 CPS schools. The CHC members were considered major stakeholders in this initiative. Many of the CHC members represent minority populations, and the asthma program provided an excellent opportunity for them to gain insight about an illness that negatively affects their communities. In providing multiple services to underserved communities, CHC members developed community awareness and the recognition that community service is a crucial factor in the revitalization of inner-city areas. The CHC members who work in schools offer positive role models for children, while at the same time enhancing health education in schools that have limited budgets for traditional health-education promotion programs.
It is too soon to know whether the CHC strategies have been effective in their ultimate goal of reducing asthma morbidity and mortality rates in the selected community areas served by the schools. However, the CHC has demonstrated that trained volunteers can effectively conduct asthma education programs in schools.
The CHC encountered several issues in implementing this program, including access to established bureaucracies, adapting a professionally prepared curriculum to environmental reality, and the limitations of a single-topic curriculum without the benefit of an integrated comprehensive health program. Finding appropriate contact personnel in each school and finalizing arrangements for implementing the program were also challenging. School nurses were identified as appropriate contacts; however, CPS nurses are usually assigned to several schools and may only be available once or twice a week at any one school. Likewise, arranging dates and times for the CPS staff hindered program implementation.
The CHC team also learned that most of the schools do not incorporate comprehensive health education programs in the curricula offered to students. For example, health education programs for inner-city schools can address multiple health problems such as lead poisoning, asthma, and violence. In selecting a curriculum prepared and distributed by a nationally recognized group, the CHC team had assumed that the tools used in assessing the students' learning abilities would have content validity and reliability. However, CHC members were surprised when, during a focus group interview, children associated asthma triggers with triggers on firearms.
The team also found that volunteers sometimes needed opportunities to "debrief" with CHC staff health professionals after encountering difficult classroom situations that they were not trained to handle. For example, there were some children who reported witnessing domestic violence and associated this with asthma "management." One child remarked, "I saw my dad beating my mom last night while standing in the kitchen. He got angry and screamed at me to go to my room. I was afraid and ran into my room and later I had an asthma attack." Another group of children was highly mobile (ie, moving from the care of one relative to another on a daily basis). The CHC members required ongoing support as they considered how such factors could be incorporated when implementing the asthma education program in the schools.
It quickly became obvious to the CHC team that environmental pollutants are factors that cause many asthma episodes. Special emphasis was placed on teaching children skills they could use to avoid irritants at home that would trigger their asthma. However, it became apparent that while such information is worthwhile, many of the children had little control over environmental irritants. One student remarked: "You said that cigarette smoke is a trigger for my asthma, but my mother smokes a lot, especially at night. How can I tell her to stop smoking?"
The various responses of the children underscored the importance of a comprehensive asthma program with strategies to ensure parental involvement. While parental education offers the added possibility of preventing subsequent physical, social, and emotional problems for asthmatic children, engaging the participation of parents in urban school programs remains a challenge.
Despite the progress made in asthma treatment, childhood asthma morbidity and mortality rates remain high, especially among African Americans and other minority populations. The CHC team's strategy of using lay health-care workers for school-based health education offers a means for reaching children and some parents. This strategy requires the participation of health-care professionals and the collaboration of other stakeholders (parents, school personnel, and community organizations) to achieve success. A critical factor in the successful implementation of this project is the mobilization of human resources (ie, CHC members, parents, teachers, the Chicago Lung Association, and nurses at the selected schools). A low-cost intervention such as the Chicago Health Corps Asthma Program effectively reaches multiethnic inner-city communities and appears to help improve awareness, asthma management, and patient education.
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