TABLE 1.
Characteristics of Studies of Pediatric Asthma Education Included in Meta-analysis
| Authors | Type of Study | Sample Sizea |
Type of Comparison | Type of Education | No. of Sessions (Contact Time) |
Topics Addressed | Severity | Socioeconomic Status |
|---|---|---|---|---|---|---|---|---|
| Alexander et al12 (1988) | RCT | 21 | Education vs usual care | Individual education | Not stated | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but all had at least 1 ED visit in the previous 12 mo | 100% enrolled in Medicaid and had no usual source of care |
| Anderson et al13 (2004) | Controlled observational study | 54 | Education vs usual care | Not stated | Not stated | Not stated | Not stated | Family income = $0–36 335, 78% Medicaid, 11% State Children's Health Insurance Program, 11% indigent |
| Bartholomew et al14 (2000) | RCT | 133 | Education vs usual care | Educational computer game | Not stated | Medication usage, symptom monitoring, avoiding triggers | 33% mild, 36% moderate, 31% severe | 48% Medicaid, 31% no insurance, 7% health maintenance organization, 7% Medicare, 7% self-pay |
| Brown et al15 (2002) | RCT | 95 | Education vs usual care | Individual education | 8 sessions (12 h) | Not stated | 19% mild intermittent, 56% mild persistent, 21% moderate persistent, 4% severe persistent | 82% enrolled in Medicaid |
| Butz et al16 (2005) | Cluster RCT | 201 | Education vs usual care | Group education | 3 sessions (5 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | 39% mild intermittent, 39% mild persistent, 12% moderate persistent, 11% severe persistent | Parent income: 6% less than $10 000, 23% $10 000–29 999, 34% $30 000–39 999, 35% $40 000 + |
| Butz et al17 (2006) | RCT | 181 | 2 different asthma education interventions | Individual education, focused on nebulizer use vs focused on use of asthma action plan | 6 sessions (6 h) vs 3 sessions (3 h) | Medication usage, symptom monitoring | 5% mild intermittent, 61% mild persistent, 21% moderate persistent, 14% severe persistent | 80% enrolled in Medicaid; 100% lived in inner-city areas |
| Chan et al18 (2007) | RCT | 120 | 2 different asthma education interventions | Internet-based education plus individual, in-person education vs individual in-person education | Not stated | Medication usage, symptom monitoring | 18% mild persistent, 68% moderate persistent, 14% severe persistent | Dependents of active-duty or retired military personnel |
| Christiansen et al19 (1997) | Controlled observational study | 52 | Education vs usual care | Group education | 5 sessions (1 h, 40 min) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | Lived in inner city |
| Clark et al20 (1986) | RCT | 310 | Education vs usual care | Group education | 6 sessions (6 h) | Medication usage, symptom monitoring, avoiding triggers | Not stated, but all had ≥1 visit to allergy clinic in the previous 12 mo | Low income and lived in inner city |
| Evans et al21 (1987) | Cluster RCT | 239 | Education vs usual care | Group education | 6 sessions (6 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | 71% received Medicaid or other public assistance |
| Evans et al22 (1999)b | RCT | 1033 | Education vs usual care | Individual education and group education | 13 sessions (not stated) | Basic facts, medication usage, avoiding triggers | Most mild | Lived in inner-city census tracts in which at least 20% of the population was below 100% of the federal poverty level |
| Farber and Oliveria23 (2004) | RCT | 56 | Education vs usual care | Individual education | 1 session (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but recruited during ED visit | 100% Medicaid; 82% had family income less than $15 000 |
| Fireman et al24 (1981) | Controlled clinical trial | 26 | Education vs usual care | Individual education and group classes | 6 sessions (8 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | 50% intermittent, 50% persistent | Most had moderate family incomes |
| Gerald et al25 (2006) | Cluster RCT | 736 | Education vs usual care | Group education | 6 sessions (3 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | Lived in an inner-city school district |
| Greineder et al26 (1999) | RCT | 57 | 2 different asthma education interventions | Individual, in-person education vs individual, in-person education plus telephone calls | ≥1 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | 100% commercial health maintenance organization |
| Guendelman et al27 (2002) | RCT | 122 | Education vs usual care | Educational Internet device | ~90 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | 26% mild, 62% moderate, 11% severe | 93% public insurance |
| Harish et al28 (2001)b | Controlled clinical trial | 129 | Education vs usual care | Individual education | 3 sessions (at least 3 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but recruited during an ED visit | Lived in low-income, inner-city area |
| Homer et al29 (2000) | RCT | 137 | 2 different asthma education interventions | Educational computer game and individual, in-person education vs individual, in-person education | 3 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Mean = moderate | 13% private health insurance |
| Joseph et al30 (2005) | Cluster RCT | 510 | Education vs usual care | Group education | Not stated | Not stated | 48% mild intermittent, 29% mild persistent, 17% moderate persistent, 6% severe persistent | 52% lived in families with incomes of less than $15 000 |
| Karnick et al31 (2007) | RCT | 212 | 3 different asthma education interventions | Individual education: in-person education vs in-person education plus telephone calls vs in-person education, telephone calls, and case management | Not stated | Basic facts, medication usage, avoiding triggers | 80% experienced symptoms ≥2 times per week | 89% Medicaid |
| Kelly et al32 (2000) | Controlled clinical trial | 78 | Education vs usual care | Individual education | 3 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but had at least 2 ED visits or 1 hospitalization for asthma in the previous 12 mo | 100% Medicaid |
| Krieger et al33 (2005)b | RCT | 214 | Asthma education interventions of differing intensities | Individual education: 7 home visits vs 1 home visit | 7 sessions vs 1 session (not stated) | Avoiding triggers | 24% mild intermittent, 14% mild persistent, 34% moderate persistent, 28% severe persistent | Enrolled in Medicaid and/or lived in households with incomes below 200% of the federal poverty level |
| Krishna et al34 (2003) | RCT | 86 | 2 different asthma education interventions | Educational computer game and individual, in-person education vs individual, in-person education | At least 3 sessions (hours varied) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but all were receiving treatment from an allergy and pulmonology clinic | Among children's parents: 9% less than high school education, 54% high school graduates, 37% some college |
| La Roche et al35 (2006) | Controlled observational study | 22 | Education vs usual care | Group education | 3 sessions (3 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | 100% low socioeconomic status |
| Levy et al36 (2006) | Cluster RCT | 243 | Education vs usual care | Group education and individual education | ~32 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | >80% enrolled in Medicaid |
| Lewis et al37 (1984) | RCT | 76 | 2 different asthma education interventions | Group education: interactive, small-group education vs lectures to large groups | 5 sessions (5 h) vs 3 sessions (4.5 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated, but used medication at least 25% of days per month | 100% enrolled in Kaiser Permanente |
| Lukacs et al38 (2002) | Controlled observational study | 298 | Education vs usual care | Individual education | Not stated | Not stated | Moderate or severe | 100% enrolled in Kaiser Permanente |
| McNabb et al39 (1985) | RCT | 14 | Education vs usual care | Individual education | 4 sessions (3 h) | Symptom monitoring | Not stated, but at least 1 ED visit in previous year | 100% enrolled in Kaiser Permanente |
| Morgan et al40 (2004)b | RCT | 821 | Education vs usual care | Individual education | Median of 5 sessions (not stated) | Basic facts, avoiding triggers | Not stated, but at least 1 hospitalization or 2 ED or urgent care visits in previous 6 mo and positive test for allergen | Lived in census tracts in which at least 20% of households had incomes below 100% of the federal poverty level |
| Persaud et al41 (1996) | RCT | 36 | Education vs usual care | Individual education | 8 sessions (2 h, 40 min) | Medication usage, symptom monitoring | 44% mild, 50% moderate, 6% severe | 69% Medicaid |
| Rubin et al42 (1986) | RCT | 54 | 2 different asthma education interventions | Educational computer game vs brief, verbal instructions | 6 sessions (4.5 h) | Medication usage, symptom monitoring, avoiding triggers | Moderately severe | Most high socioeconomic status |
| Shames et al43 (2004) | RCT | 119 | Education vs usual care | Individual education and an educational computer game | At least 3 sessions (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Moderate-to-severe | 72% Medicaid; 69% had family income less than $15 000 |
| Shields et al44 (1990) | RCT | 253 | Education vs usual care | Group education; individual education | 8 sessions (8 h) | Medication usage, symptom monitoring, avoiding triggers | Not stated, but all had at least 1 ED visit or hospitalization for asthma in the previous 4 y | Most low income |
| Sockrider et al45 (2006) | RCT | 218 | Education vs usual care | Individual education | 2 sessions (not stated) | Medication usage, symptom monitoring, avoiding triggers | 46% intermittent, 54% persistent | 85% insured, 15% uninsured |
| Teach et al46 (2006)b | RCT | 437 | Education vs usual care | Individual education | 1 session (1–1.5 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | 41% mild intermittent, 29% mild persistent, 14% moderate persistent, 16% severe persistent | 68% public insurance, 28% commercial insurance, 4% uninsured |
| Velsor-Friedrich et al47 (2004) | Cluster RCT | 102 | Education vs usual care | Group education | 6 sessions (4.5 h) | Basic facts, medication usage, symptom monitoring, avoiding triggers | Not stated | 100% Temporary Assistance for Needy Families; 100% resided in inner-city neighborhoods |
| Walders et al48 (2006) | RCT | 175 | 2 different asthma education interventions | Individual education: comprehensive education plus a 24-h advice line vs education about metered-dose inhalers | 2 sessions vs 1 session (not stated) | Basic facts, medication usage, symptom monitoring, avoiding triggers | 15% mild intermittent, 40% mild persistent, 33% moderate persistent, 12% severe persistent | Lived in inner-city area |
a
In all cases, the sample size refers to the number of children for whom data were collected for the outcomes of interest to this meta-analysis. In some cases, these sample sizes are smaller than the total number of children enrolled in the study as a result of attrition or missing data.
b
In addition to education, included ≥1 environmental control intervention such as providing bedding encasements, air purifiers, low-emission vacuums, and pest-control products and services and referring family members for smoking-cessation counseling.