Adolescents with asthma face unique challenges due to hormonal changes, psychosocial development and healthcare transition. Peer-led self-management programmes may increase treatment adherence and social adjustment by addressing these challenges. The purpose of this study was to assess whether peer-led self-management programmes improve health outcomes for adolescents with asthma.
Methods:
Sixteen databases were searched in May 2015 for published and unpublished studies. Studies had to be randomised controlled trials (RCTs), include participants aged 10–19 years old with asthma, use a peer-led educational intervention that addressed self-management of asthma, and report a measure of health status or behaviour as an outcome. Trial quality and data extraction were based on pre-specified criteria. Results were pooled using a random-effects model with mean differences (MDs). Subgroup analysis was not possible due to limited data.
Results:
Of the 1,887 articles retrieved, 4 studies (n = 1,937 participants) met the inclusion criteria. One study was excluded from meta-analysis due to unextractable data. There was a small, statistically non-significant increase in participants’ quality of life (MD = 0.70, 95% confidence interval [CI] = −0.29, 1.69, p = .16), and a small, statistically non-significant decrease in lung function (MD = −1.36, 95% CI = −9.98, 7.26, p = .76). In one RCT, interventions reduced asthma symptoms and improved self-management. Scarcity of data made meta-analysis unfeasible, and studies had unclear or high risk of bias.
Discussion:
There is limited evidence that peer-led self-management programmes improve quality of life or lung function for adolescents with asthma. RCTs investigating more diverse and longer term outcomes are needed.
AkinbamiLJSchoendorfKC (2002) Trends in childhood asthma: Prevalence, health care utilization and mortality. Pediatrics110: 315–322.
2.
Al-sheyabNGallagherRCrispJet al. (2012) Peer-led education for adolescents with asthma in Jordan: A cluster-randomized controlled trial. Pediatrics129(1): e106–112.
3.
Backett-MilburnKWilsonS (2000) Understanding peer education: Insights from a process evaluation. Health Education Research15(1): 85–96.
4.
BanduraA (1986) Social Foundation of Thoughts and Action. Englewood Cliffs, NJ: Prentice-Hall.
5.
BanduraA (1997) Self Efficacy: The Exercise of Control. New York: W. H. Freeman.
6.
BonellCJamalFMelendez-TorresGJet al. (2015) ‘Dark logic’: Theorizing the harmful consequences of public health interventions. Journal of Epidemiology and Community Health69: 95–98.
7.
BorensteinMHedgesLVHigginsJPTet al. (2009) Introduction to Meta-analysis. West Sussex: John Wiley & Sons.
8.
BradyTJMurphyLO’ColmainBJet al. (2013) A meta-analysis of health status, health behaviors, and healthcare utilization outcomes of the chronic disease self-management program. Preventing Chronic Disease10: 120112.
9.
BuryMNewbouldJTaylorD (2005) A Rapid Review of the Current State of Knowledge regarding Lay-led Self-management of Chronic Illness: Evidence Review. London: National Institute for Health and Clinical Excellence.
10.
CanovaCBurneyPJarvisD (2011) Seasonal variations in asthma attacks and grass sensitisation. European Respiratory Journal38(S5): 3226.
11.
ClarkNMShahSDodgeJAet al. (2010) An evaluation of asthma interventions for preteen students. Journal of School Health80(2): 80–87.
12.
CourielJ (2003) Asthma in adolescence. Paediatric Respiratory Reviews4(1): 47–54.
13.
De BenedictisDBushA (2007) The challenge of asthma in adolescence. Pediatric Pulmonology42(8): 683–692.
14.
DeeksJJHigginsJPTAltmanDG (2011) Chapter 9: Analysing data and undertaking meta-analyses. In: HigginsJPTGreenS (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available from www.handbook.cochrane.org.
15.
DishionTJMcCordJPoulinF (1999) When interventions harm: Peer groups and problem behavior. American Psychologist54: 755–764.
16.
DonnerAKlarN (2004) Pitfalls of and controversies in cluster randomization trials. American Journal of Public Health94(3): 416–422.
17.
EggerMZellweger-ZähnerTSchneiderMet al. (1997) Language bias in randomised controlled trials published in English and German. The Lancet350: 326–329.
18.
FosterGTaylorSJCEldridgeSet al. (2007) Self-management education programs by lay leaders for people with chronic conditions (review). Cochrane Database of Systematic Reviews4: CD005108.
19.
GibsonPGShahSMamoonHA (1998) Peer-led asthma education for adolescents: Impact evaluation. Journal of Adolescent Health22: 66–72.
GriffithsCFosterGRamsayJet al. (2007) How effective are expert patient (lay led) education programs for chronic disease?British Medical Journal334: 1254.
22.
GuevaraJPWolfFMGrumCMet al. (2003) Effects of educational interventions for self management of asthma in children and adolescents: Systematic review and meta-analysis. BMJ326(7402): 1308–1309.
23.
HardenAOakleyAOliverS (2001) Peer-delivered health promotion for young people: A systematic review of different study designs. Health Education Journal60(4): 339–353.
24.
HawleyK (2010) The theory, philosophy, and process of developing the Staying Positive Program for adolescents with long term medical conditions. In: JonesFR (ed.) Working with Self-management Courses: The Thoughts of Participants, Planners, and Policy-makers, pp 33–40. New York: Oxford University Press.
25.
HigginsJPTAltmanDGSterneJAC (2011) Chapter 8: Assessing risk of bias in included studies. In: HigginsJPTGreenS (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available at: www.handbook.cochrane.org.
26.
HigginsJPTDeeksJJ (2011) Chapter 7: Selecting studies and collecting data. In: HigginsJPTGreenS (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available at: www.handbook.cochrane.org.
27.
JonssonMEgmarACHallnerEet al. (2014) Experiences of living with asthma – A focus group study with adolescents and parents of children with asthma. Journal of Asthma51(2): 185–192.
28.
JuniperEFGuyattGHFeenyDHet al. (1996) Measuring quality of life in children with asthma. Quality of Life Research5(1): 35–46.
29.
JuniperEFGuyattGHWillanAet al. (1994) Determining a minimal important change in a disease-specific Quality of Life Questionnaire. Journal of Clinical Epidemiology47(1): 81–87.
30.
KimCRFreeC (2008) Recent evaluations of the peer-led approach in adolescent sexual health education: A systematic review. International Family Planning Perspectives34(2): 89–96.
31.
KirkSBeattySCalleryPet al. (2010) Evaluation self-care support for children and young people with long-term conditions: Report for the National Institute for Health Research Service Delivery and Organization Program. SDO Project. Available at: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1715-162_V01.pdf (accessed 24 February 2015).
32.
KyngasH (2004) Support network of adolescents with chronic disease: Adolescents’ perspective. Nursing and Health Sciences6(4): 287–293.
33.
LewinSADickJPondPet al. (2005) Lay health workers in primary and community health care. Cochrane Database of Systematic Reviews25: CD004015.
34.
LindsaySKingsnorthSMcdougallCet al. (2014) A systematic review of self-management interventions for children and youth with physical disabilities. Disability and Rehabilitation36(4): 276–288.
35.
McGowanP (2006) The Chronic Disease Self-management Program: Program Evaluation. Victoria, British Columbia: BC Self-Management. Available at: http://www.coag.uvic.ca/cdsmp/cdsmp_research.htm (accessed 31 June 2015).
36.
MellanbyARReesJBTrippJH (2000) Peer-led and adult-led school health education: A critical review of available comparative research. Health Education Research15(5): 533–545.
37.
MoherDLiberatiATetzlaffJet al. (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine151(4): 264–269.
38.
MooreGAudreySBarkerMet al. (2014) Process evaluation in complex public health intervention studies: the need for guidance. Journal of Epidemiology and Community Health68: 101–102.
PaiALHMcGradyM (2014) Systematic review and meta-analysis of psychological interventions to promote treatment adherence in children, adolescents, and young adults with chronic illness. Journal of Pediatric Psychology39(8): 918–931.
42.
ReevesBCDeeksJJHigginsJPTet al. (2011) Chapter 13: Including non-randomized studies. In: HigginsJPTGreenS (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Available from www.handbook.cochrane.org. (accessed 10 June 2015).
43.
RheeH (2007) Adolescents’ psychosocial experiences living with asthma: A focus group study. Journal of Pediatric Health Care21(2): 99–107.
44.
RheeHBelyeaMJCiurzynskiSet al. (2009) Barriers to asthma self-management in adolescents: Relationships to psychosocial factors. Pediatric Pulmonology44: 183–191.
45.
RheeHBelyeaMJHuntJFet al. (2011) Effects of a peer-led asthma self-management program for adolescents. Archives of Pediatrics and Adolescent Medicine165(6): 513–519.
46.
RogersA (2009) Advancing the expert patient?Primary Health Care Research & Development10: 167–176.
47.
SadofMKaslovskyR (2011) Adolescent asthma: A developmental approach. Current Opinion in Pediatrics23: 373–378.
48.
SalinasME (2007) Evaluation study of the Staying Positive Pilot Workshops: A self management program for young people with chronic conditions. DIPEx Research Group, Department of Primary Health Care, University of Oxford.
49.
SanterMRingNYardleyLet al. (2014) Treatment non-adherence in pediatric long-term medical conditions: Systematic review and synthesis of qualitative studies of caregivers’ views. Boston Medical Center Pediatrics14: 63.
50.
ShahSPeatJKMazurskiEJet al. (2001) Effect of peer led program for asthma education in adolescents: Cluster randomised controlled trial. BMJ (Clinical Research ed.)322(7286): 583–585.
51.
SleightAD (1997) Self-regulated learning during non-linear self-instruction, educational psychology. Michigan State University. Available at: https://msu.edu/~sleightd/srl.html
52.
SrofBTaboasPVelsor-FriedrichB (2012) Adolescent asthma education programs for teens: Review and summary. Journal of Pediatric Health Care26(6): 418–426.
53.
TolliMV (2012) Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: A systematic review of European studies. Health Education Research27(5): 904–913.
54.
Van CleaveJGortmakerSLPerrinJM (2010) Dynamics of obesity and chronic health conditions among children and youth. JAMA303(7): 623–630.
55.
Velsor-FriedrichBVlassesFMoberlyJet al. (2004) Talking with teens about asthma management. Journal of School Nursing20(3): 140–148.
56.
WarnerL (2005) Speech by Lord Warner. In: Minister of State for NHS Delivery (Lords), Expert Patient Program Annual Conference, 22 November.
57.
WarsiAWangPSLaValleyMPet al. (2004) Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Archives of Internal Medicine164(15): 1641–1649.
58.
WeeksASwerissenH (2005) Self-management and chronic illness. In: BrowningCJThomasSA (eds) Behavioral Change: An Evidence-based Handbook for Social and Public Health. London: Elsevier Limited, pp. 243–266.
59.
WeiJGerlichJGenuneitJet al. (2015) Hormonal factors and incident asthma and allergic rhinitis during puberty in girls. Annals of Allergy, Asthma, & Immunology115(1): 21–27.
ZebrackiKDrotarD (2004) Outcome expectancy and self-efficacy in adolescent asthma self-management. Children’s Health Care33: 133–149.
62.
ZhaoHGuoYZhangAet al. (2013) A model for pain self-management of patients with haemophilia: Peer education. In: Proceedings of the 2013 international conference on the modern development of humanities and social science, pp. 186–189. Hong Kong: Atlantis Press.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
