Peer-led Asthma Programs Preferred by Adolescents Living in Urban Areas

Hyekyun Rhee, PhD

New data asthma education methods found that peer-led asthma self-management education more effective than adult-led programs in improving asthma outcomes, with improvements being sustained for up to 15 months.

The findings suggested that the disproportionate asthma burden in racial and ethnic minority adolescents living in urban communities could be addressed through peer-led self-management programs.

Prior to the study, the long-term effectiveness of peer-led asthma programs was not established, though they were found to be effective in improving quality of life in school-based studies outside of the United States.

In a multi-site randomized clinical trial led by Hyekyun Rhee, PhD, University of Rochester, a team of investigators examined the long-term effects of a peer-led program on asthma outcomes in adolescents living in urban areas compared to a conventional adult-led approach in 3 US metropolitan communities.

The Methods

The study was conducted in Buffalo, New York, as well as Baltimore, Maryland, and Memphis, Tennessee, between 2015 and 2019.

Recruitment was conducted at clinical practices (29.7%) as well as schools (22.5%), word of mouth (20%), and through advertisements (10.3%).

Eligible criteria required that participants were 12 to 17 years of age, in a urban residency, asthma diagnosis for at least 1 year, persistent asthma defined by the Expert Panel Report-3 (EPR-3)criteria or current use of a controller medication, asthma-related health care utilization in the past 12 months, and proficiency in the English language.

In the end, a total of 320 adolescents participated in the study, a majority of whom were Black ir African American (78.4%), with public health insurance (72.5%).

Of the 320 enrolled, 303 participants were included in the longitudinal analysis.

Participants were divided between intervention and control groups, though all participants attended a day camo where a manualized asthma self-management program was implemented.

The intervention group attended a camp where trained peer leaders delivered the program to a small group of 4 to 8 adolescents, with peer leaders conducting bimonthly contacts occurring every other month using a standardized script for 12 months.

Adult leaders (asthma educators or nurse practitioners) led the control group and delivered identical educational content at the same venue as the intervention group.

Investigators utilized the Pediatric Asthma Quality of Life Questionnaire to measure symptoms, activity limitations, and emotional functioning of each participant in the past 2 weeks. This was considered the primary outcome of the study.

Secondary outcomes included asthma control, asthma self-management, and lung function.

The Findings

Though uality of life improved over 15 months for both groups for all 3 subscales in the study, the intervention group showed greater improvement than the control group in overall quality of life (AMD at 15 months, 0.75 vs 0.37; between-group AMD, 0.38; 95% CI, 0.07-0.63).

Asthma control also improved over time for both groups, though the improvement was greater in the intervention group than in the control group (15-month AMD, −0.59 vs −0.31; between-group AMD, −0.28; 95% CI, −0.51 to −0.01).

Investigators noted that male participants had better controlled asthma regardless of group.

Overall, the investigative team found that program effects were greater when led by peer leaders than health care professionals, which suggested that peer-led approaches acted as a “promising strategy” when delivering asthma self-management education for racial and ethnic minority adolescents living in urban areas.

“A peer-led asthma program implemented in venues such as schools, houses of worship, or clinics can improve access to asthma education, ameliorating the disproportionate burden of asthma morbidity in racial and ethnic minority adolescents residing in large US urban communities,” the team wrote.

The study, “Long-term Effectiveness of a Peer-Led Asthma Self-management Program on Asthma Outcomes in Adolescents Living in Urban Areas :A Randomized Clinical Trial,” was published online in JAMA Open Network.