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Peer-led self-management programmes may not help teenagers with asthma

A study from Warwick University suggests peer-led self-management programmes have little impact on the quality of life or lung function of adolescents with asthma, but concludes more data is needed to provide evidence for this

Peer-led self-management programmes differ from typical patient education in that they encourage patients to take an active role in managing their condition. While traditional self-management programmes are taught by professionals, new programmes are taught by peers of equal standing who belong to the same social group.

Asthma is a common, chronic condition in adolescents and unlike children or adults, young people face distinct challenges because of puberty, peer pressure, psychosocial development, and healthcare transition, according to GJ Melendez-Torres who led the study. “Asthma symptoms can be exacerbated by hormonal changes and new exposures, such as cigarettes and drugs. In addition, adolescents often experience fear, anxiety, and shame about their illness, and may not take their medication as prescribed, to fit in with their peers.”

As a result, young people aged 11-17 have double the risk of dying from asthma than children aged 10 and under, calling for new approaches to address these adolescents' concerns.

In the US peer-led management is a critical component of the National Heart, Lung, and Blood Institute’s National Asthma Education and Prevention Program (NAEPP) asthma guidelines. These programmes use organised learning to facilitate healthy behaviours, such as treatment adherence and dealing with emotions. The use of peers has advantages such as providing role models, interpreting health advice in a manner relevant to adolescents, cutting the cost of staff budgets and benefiting the educators themselves.

Sixteen databases were searched in May 2015 for published and unpublished studies. Studies had to be randomised controlled trials (RCTs); they had to 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.

The researchers retrieved 1,887 articles and found four studies of peer-led management programmes that met their inclusion criteria. Their analysis revealed a small, statistically non-significant increase in participants’ quality of life, and a small, statistically non-significant decrease in lung function. In one randomised controlled trial interventions reduced asthma symptoms and improved self-management. However overall, a lack of data made meta-analysis unfeasible, and studies had unclear or high risk of bias.

Co-author Connie Zhong, of Harvard Medical School said, “According to social learning theory, young people are more likely to have positive attitudes towards modelled behaviours if they can relate to their teachers. By interacting with educators of similar age and backgrounds, adolescents can seek guidance and increase their self-efficacy to achieve health behaviour change. Also role models provide a means for peer identification, which reduces feelings of isolation and increases feelings of normalcy. By normalising health behaviours, adolescents may better adhere to treatments, leading to improved health.”

The study concludes that randomised clinical trials that investigate more diverse and longer-term outcomes are needed.

The Effect of Peer-Led Self-Management Education Programmes for Adolescents with Asthma: A Systematic Review and Meta-Analysis is published in Health Education Journal.

http://journals.sagepub.com/doi/10.1177/0017896917712297

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