Breathe Well, Live Well: Adult Asthma Management Education BWLW... · educators in the community to...
28
1 1 Breathe Well, Live Well: Adult Asthma Management Education Kristal Fuentes American Lung Association Beth Ash Thermo Fisher Scientific Friday, February 22, 2019
Transcript of Breathe Well, Live Well: Adult Asthma Management Education BWLW... · educators in the community to...
11
Breathe Well, Live Well:Adult Asthma Management
Education
Kristal FuentesAmerican Lung Association
Beth AshThermo Fisher Scientific
Friday, February 22, 2019
22
Asthma in Adults
• 24.6 million Americans have asthma, including 18.4 million adults• 12.1 million Americans (9.0 million adults) reported having an asthma
episode• 2.1 million ED visits and 1.2 million hospitalizations for asthma• Asthma costs the nation $56 billion every year
– These costs include direct health care expenses and indirect costs such as lost in productivity
• Approximately 16% of American adults with asthma either developed the condition on the job or have their symptoms worsen by their workplace.
Presenter
Presentation Notes
Asthma remains a major public health concern. While there has been a tremendous focus over the years on the needs of children, there has been a lack of comparable focus on the needs of adults. 24.6 million Americans have asthma including 18.4 million adults with a current diagnosis. Half of those adults (9.0 million) experience an asthma episode each year Far too many people with asthma lack a usual source of care which makes managing asthma a challenge In 2014, CDC reported that there were 2.1 million ED visits for asthma and 1.2 million hospitalizations All indicators of poor asthma control
33
Breathe Well, Live Well Educator Training
Breathe Well, Live Well Educator TrainingBreathe Well, Live Well® Educator Training is a free one-hour interactive online learning module designed to prepare asthma educators in the community to deliver asthma self-management education to adults and families. This course is ideal for healthcare practitioners, Certified Asthma Educators (AE-C), Certified Health Education Specialists (CHES) and Community Health Workers wanting to improve asthma control and the quality of life of people living with asthma.
Presenter
Presentation Notes
Brief overview of BWLW program. Mention CDC-funding to support the work. Describe the BWLW Educator Training Describe the benefits to bringing the training online.
4
2005
2007
2013
2017
About Breathe Well, Live Well
Disseminated community-based program nationwide
Piloted adapted validated, clinic-based program for small group community-based implementation
Adapted to a self-help guide
2017 Updates:• Reviewed content &
updated language • Updated branding • Added writing lines• Added new devices
Presenter
Presentation Notes
I’d like to take you on a historical journey through the development and implementation of Breathe Well, Live Well and what this means for our organization. The development of the program began as part of a CDC-funded grant project to address the gaps in asthma education. There was a tremendous lack of focus on needs of adults with asthma. So, we combed the literature and brought together experts to identify an effective adults asthma education program. We adapted an effective clinic-based group education program for community-based implementation and in 2005 piloted the group education model. We launched the program nationwide in 2007. Through evaluation and feedback collected over the years, the group education model proved to be challenging. It was challenging for Chartered Lung Associations to identify partners and it was challenging for Facilitators to recruit participants. Recruitment in the group education model worked well for Health plans and Employers. The group education model could still be considered for these groups. In 2013, we fine-tuned the workbook, adding information about workplace exposures and made it into a self-help guide. While we never intended for adults with asthma to pick up a workbook and magically master asthma self-management education, instead, we expanded the program delivery model so that it could be used one-on-one in a clinic or in a home setting. The formal BWLW Facilitator Trainings, using a TTT model, were eliminated at that time. The BWLW workbooks continued to be sold through Krames StayWell. In 2017, we selected to add an Educator Training to provide a service and resource to the healthcare practitioners and community health educators delivering adult asthma education. Today, Breathe Well, Live Well remains the only proven effective adult asthma education program that is nationally available.
55
Proven Effective
• Adapted from a effective clinic based program, “Winning with Asthma” from researchers at UAB for community based implementation
• Studies showed that after completing the program:–Participants experienced less severe asthma symptoms,
–had fewer respiratory problems and,
–better able to stick to their asthma treatment plan.
Presenter
Presentation Notes
Why use and promote Breathe Well, Live Well? It’s the only nationally available program BWLW is based on an effective adult asthma education program developed by researchers at UAB Study results showed that participants experienced less severe asthma symptoms, had fewer respiratory problems and were better able to stick to their asthma treatment plan With experts, the Lung Association adapted the clinic intervention for community based implementation The community-based program consisted of 4-5 hours of education delivered by an American Lung Association-trained facilitators to adults in small groups.
66
Community-based Implementation
• Pilot Results – Group Education Model– Increased asthma knowledge
– Improvements in confidence to manage asthma
– Improvement in asthma self-management practices
• In-home Asthma Education Program usingBreathe Well, Live Well– Improved access to care
– Reduced use of emergency services
– Improved self-management practices & health outcomes
WINNER
Gold Award & Best in Show2014 National Health Information Awards
Presenter
Presentation Notes
Why use and promote Breathe Well, Live Well? Results from the pilot of the adapted program showed that the program was effective in increasing asthma knowledge, confidence in managing asthma, and increased the frequency of asthma self-management practices. In addition, we received positive results on the quality of the education, the workbook, and satisfaction with the program. Furthermore, a 2013 analysis of the program used by American Lung Association-trained community health workers in Long Beach, CA showed that the program improved
77
Aligns with EPR-3
• Basic facts about asthma• Roles of asthma medicines• Patient skills
–Medication–Devices–Identifying and avoiding asthma triggers
• Self-monitoring• Using a written asthma action plan
Presenter
Presentation Notes
BWLW aligns with the key educational messages in the National Asthma Guidelines, including: The basic facts about asthma – our education include the contrast between normal airways and airways with asthma; what is airflow obstruction and how it happens; role of inflammation in asthma; what happens to the airways in an asthma attack; and understanding that the absence of symptoms does not mean the absence of disease The program describes the roles of medications - understanding the difference between long-term control medications, quick-relief medications, and the intended role of all other medications The program teaches patient skills - medication skills: correct performance of various inhaler techniques (demonstration and return demonstration); device usage: valved-holding chamber, spacer, nebulizer, and peak flow meter; and environmental control measures - identifying and avoiding environmental exposures that worsen the patient’s asthma (eg, allergens, irritants, and tobacco smoke); teach patients how environmental allergens and irritants can make the patient’s asthma worse at home, school, or work; and how to recognize immediate and delayed reactions; teach patients strategies for removing or decreasing exposure to allergens and irritants to which they are sensitive from their living spaces; when possible, refer for evaluation and direct toward effective, home-based education programs for allergen and irritant control; advise all patients not to smoke tobacco and to avoid secondhand tobacco smoke and emphasize the importance of not smoking for women who are pregnant and for parents around their small children; provide resources for smoking cessation and avoidance strategies to adults who smoke around children The program teaches self-monitoring – to assess level of asthma control and goals for improvement; monitor symptoms and, if prescribed, peak flow; recognize early signs and symptoms of worsening asthma; The program teaches the value of a written asthma action plan and how to use it to manage asthma - to know when and how to take daily actions to control asthma; adjust medication in response to signs of worsening asthma seek medical care as appropriate
88
Aligns with National Standards for Asthma Self-Management Education
Standard 7. A written curriculum with criteria for successful learning outcomes
• The instructional materials should be high quality and selected for the intended audience, taking into consideration variables such as cultural appropriateness, visual correctness, and reading level.
–Accomplish the goals of successful asthma management
–Establish and attain individual treatment goals
A. Gardener et al. National standards for asthma self-management education. Ann Allergy Asthma Immunology 114 (2015) 178-186
Presenter
Presentation Notes
BWLW also aligns with the National Standards for Asthma Self-Management Education. The workbook was designed with high priority populations in mind and takes into consideration variables such as cultural appropriateness, visual correctness, and reading level. We aimed to create the materials at a 4th grade reading level, using best practices for lower literacy, such as: white space, chunking the information so it is easy to understand, and few multi-syllabic words. We use a diverse group of individuals throughout the workbook to help program participants self-identify with the learning. The National Standards call for the selected program to enable participants to: accomplish the goals of successful asthma management, and establish and attain individual treatment goals. BWLW addresses both of these. For example, at the beginning of the program, clients in partnership with the educator go through a goal setting exercise. The goals are reviewed at the end of the program to assess if the client achieved their goals. In addition, asthma control is assessed through the pre- and post tests.
99
Course Goals
Educators will be able to:1. Understand the impact of poor asthma control.2. Describe the treatment and prevention of asthma symptoms.3. Explain the concepts of asthma self-management education.4. Describe the evidence-based and evaluation of Breathe Well,
Live Well ®.5. Use the Breathe Well, Live Well ® guide to provide education
sessions directly to adults with asthma.
Presenter
Presentation Notes
What are the goals of the course? [Turn presentation over to Jasmine] I would like to turn the presentation over to Jasmine to speak in more detail about the Educator Training
1010
Breathe Well, Live Well® Educator Training - Components
• Asthma Basics is a prerequisite for the Breathe Well, Live Well Educator Training–One-hour interactive learning module–Includes American Lung Association What is Asthma animation–Includes asthma medication devices and demonstration videos
and downloads• Breathe Well, Live Well Educator Training
–One-hour interactive learning module–Resources to help implement and evaluate the program
Presenter
Presentation Notes
Next I will be walking you through the components of the Breathe Well, Live Well Educator Training. The training is comprised of two stand alone modules; Asthma Basics and Breathe Well Live Well Educator Training. Asthma Basics is a prerequisite to the educator training. It is a one-hour interactive learning module designed to help people learn more about asthma. The program teaches participants to recognize triggers, understand the value of an asthma action plan, and recognize and respond to a breathing emergency. Asthma Basics includes the “What is Asthma” animation, and asthma device and demonstrations videos that show participants how to properly use their asthma medication. Educators must receive a passing grade of 80% or better on the final quiz to obtain a certificate of completion and continue to the educator training. The Breathe Well, Live Well Educator Training includes five modules that need to be completed. The course can take up to an hour, but does not need to be completed in one sitting. Throughout the course educators will receive resources to help implement and evaluate the program and a certificate of completion.
1111
Inside the Guide…
• Understanding your asthma• Building your asthma support team• Taking asthma medicines• Using tools for daily self-
management • Following good health habits
Presenter
Presentation Notes
So, let’s talk about what’s inside Breathe Well, Live Well: The Guide to Managing Asthma at Home and Work. The BWLW guide breaks the process down into five easy to follow steps – each are a section in the workbook, including: Understanding your asthma building your asthma support team taking asthma medicines using tools for daily self-management, and following good health habits. How to access the BWLW Workbook… We are encouraging Educators to contact their local Lung Association to purchase BWLW Workbooks. Workbooks are sold by our nationwide publisher, Krames StayWell, for $5.99 with a minimum order of 25 workbooks The workbook can be purchased directly from the Krames StayWell website
1212
Module Objectives:
1. Provide an overview of the course
2. Identify the completion requirements
3. Explain the history and goals of the American Lung Association
Module 1: About Breathe Well, Live Well® Educator Training
Presenter
Presentation Notes
The first module in the educator training is entitled About Breathe Well Live Well Educator Training. It has three main objectives; to provide educators with an overview of the course and the completion requirements, as well as, introduce educators to the history of the American Lung Association and our mission and goals. Each module includes a “Take a Breather” Quick Check to review the information that is presented within them.
1313
Module Objectives:1. Explain the background
history of Breathe Well, Live Well®
2. Discuss the research that supports the program
Module 2: Why Use Breathe Well, Live Well®
Presenter
Presentation Notes
The second module is entitled Why use Breathe Well Live Well. During this module educators will learn about the background and history of Breathe Well Live Well and the research that supports it, as Barbara has presented earlier in the presentation.
1414
Module Objectives:1. Explain program goals and
objectives2. Describe Breathe Well, Live
Well® materials and components
3. Identify program delivery options
4. Conduct program evaluations
Module 3: Program Impact
Presenter
Presentation Notes
The third module is entitled Program Impact. Here educators will learn the goals and objectives of Breathe Well, Live Well, its materials and components, various delivery options in order to tailor the program to the participant’s needs and how to conduct program evaluations.
1515
Module Objectives:1. Set up learning environments2. Apply principles of cultural
competency3. Apply good facilitation
techniques4. Use strong communication
skills5. Address client responses6. Use risk management
strategies
Module 4: Facilitation Skills
Presenter
Presentation Notes
Module four focuses on facilitation skills. It includes numerous tips to help educators feel more prepared to provide adult asthma education. The objectives in this module include learning the importance of creating a space that engages participants during the learning process, the importance of applying principles of cultural competency and good facilitation techniques such as strong communication skills, how to address participants’ responses appropriately and how to identify and manage the potential risks when working with adults. Lastly, in this module educators will go through case-based scenarios that highlight the dialogue and negotiation skills to motivate behavior change.
1616
Module Objectives:1. Recall the key concepts
from each module2. Identify how to order
resources3. Obtain your Certificate of
Completion
Wrap Up and Resources
Presenter
Presentation Notes
The last module is a wrap up module. It will recall the key concepts from each module in the course and tell educators how to order the Breathe Well Live Well workbook to start implementation. At the end of module it will instruct educators how to obtain their certificate of completion.
1717
Marketing Toolkit
• Breathe Well, Live Well Recruitment Flyer
• Patient Recruitment Flyer
• Educator Recruitment Email Template
• Partner Organization Recruitment Email Template
Presenter
Presentation Notes
In the current iteration of the toolkit we’ve created flyers and email templates to help you connect with community partners and potential educators
1818
• Stacked & Horizontal Web Banners
• Email Signature
• Social Media Content
• Partner Promotional Content–Can be used in e-newsletters or featured in online
learning courses
Marketing Toolkit
Presenter
Presentation Notes
You’ll also find web banners, an email signature social media posts and a blurb that community partners can use in their newsletters or online learning courses to help promote Breathe Well, Live Well
1919
Course Metrics
• Evaluation Protocol and Instruments– Registration Form– Asthma Questionnaire– Participant Evaluation Form– Educator Feedback Form– Participant List
Presenter
Presentation Notes
Evaluation Protocol and Instruments As part of the Breathe Well Live Well program we are asking educators to use our evaluation protocol and instruments packet with their clients to help evaluate the program in order to determine if the program meets its objectives and is effective. The packet includes a registration form, multiple copies of the asthma questionnaire to be delivered pre and post education, a participant evaluation form that allows participants to reflect on the education that they received and if they feel more confident and satisfied. The packet also includes two forms that are geared towards the educator; the educator feedback form and participant list. The feedback form is for us to track each of the educator’s demographic reach and how which delivery format they used. The participant form is included as a helpful took for educators to keep track of the participant ID numbers they have assigned. Mention that…Contact information for the Educators who complete the training will be uploaded to ROI and their records will be flagged that they completed the BWLW Educator Training.
2020
Educator Expectations
• Recruit 10 participants that are diverse in age, race or ethnicity, education level, and geographic location
• Maintain a roster of the number of participants that enroll and complete BWLW
• Complete and submit all required forms and record-keeping on each of the BWLW program participants.
• Complete an online facilitator feedback survey
Presenter
Presentation Notes
What are the expectations of the Educator These expectations are also outlined in the educator memorandum of understanding.
2121
Educator Timeline
Phase 1: Training
• Sign Memorandum of Understanding
• Complete Asthma Basics and Breathe Well, Live Well Educator Training
Phase 2: Implementation
• Participant Recruitment
• Program Delivery• Collecting
Participant Evaluation Forms
Phase 3: Evaluation
• Complete Educator Feedback Form
Presenter
Presentation Notes
There are three phases to becoming an educator and delivering Breathe Well, Live Well. Phase 1 is training: During this phase educators will sign the MOU and complete Asthma Basics and the BWLW Educator Training Phase 2 is implementation: In this phase educators will… -recruit participants -deliver BWLW -and collect evaluation forms from participants Phase 3 is the evaluation phase, where the educator will complete their feedback forms as send all required forms to the Lung Association. We will provide ongoing technical assistance for educators, and evaluate the training and program implementation through August
2222
Registration Process
1. Anyone who wants to learn about delivering adult asthma self-management education should email [email protected]
2. Educators will receive an welcome email outlining the Lung Association’s expectations
3. Educators willing to provide feedback must sign an Memorandum of Understanding
4. Educators receive an email with instructions to access the training
Presenter
Presentation Notes
The Educator Training is password protected. During this initial phase, we would like to gather feedback about the training and program implementation in their community. Anyone who wants to learn more or access the training should email [email protected]. Educators will receive a welcome email outlining the Lung Association’s Expectations. Educators that are willing to provide feedback must sign a Memorandum of Understanding. They will then receive a second email with instructions to access the training. These Educators will receive 10 free Breathe Well, Live Well workbooks as a token of our appreciation for providing their time and feedback.
2323
Overall Reactions to the Breathe Well, Live Well Training
“Appreciate the flexibility of the online format and the ability to take the course at my own pace”
“After taking the training I feel prepared to deliver the course and found the patient information to be very helpful”
“The Breathe Well, Live Well Educator Training helped me understand how to relay information to patients and how to guide them through self-management
of asthma and to relate it to my own experience.”
Breathe Well, Live Well Evaluation
Presenter
Presentation Notes
At the end of the first year of implementation we worked with our project evaluator, Shattuck and Associates, and interviewed each educator to develop a deeper understanding of our educators’ experiences with the Breathe Well, Live Well Training which include self-efficacy to administer the program, participant satisfaction with program content, and recommendations for program improvement. Some of the overall reactions we have received from our educators about the training are that they.. Appreciate the flexibility of the online format which allows them the ability to take the course at their own pace. Another one of our educators stated that after taking the training they felt prepared to deliver the program and found that the patient information that we provided to be very helpful. Lastly, an educator said that the training helped them understand how to relay information to patients and how to guide them through the components of asthma self-management all while relating it to their own experiences. Suggestions for Improvement Additional content on managing and eliminating triggers More real-life scenarios Provide hands-on training on proper medication techniques Supplemental information on conditions that impact, relate to asthma (e.g. COPD) Downloadable videos for when wifi is lacking Information for caregivers (especially for seniors and for children)
2424
Program Impact on Patients
Greater understanding of disease management including medications and triggers
Increased confidence in knowing and responding to asthma symptoms
Increased confidence in understanding that asthma is manageable and they can live a normal life
Breathe Well, Live Well Evaluation
“When I began, I wasn’t considering the impact these classes would have on patients from more than an informational standpoint. That changed in the very first class I offered.
During the second session of the course, one of the participants brought her medication with her to the meeting. When she opened the foil package, she shared while she filled her prescription every month,
she had never opened or used her medication because she was not aware of how to use it properly or the importance of using the controller medication as prescribed.
In an instant I realized this class will change this woman’s life and well-being on a daily basis because she now knows not only how to use her medication, but why it’s important to use it regularly.”
Presenter
Presentation Notes
When we asked the educators about the participant satisfaction with program content and the impact the program had on participants they told us that participants have shown a greater understanding… At the end of the evaluation interview we asked the educators if they would be willing to provide a testimonial about the training. On the slide you can read a testimonial from one of our educators who describes how delivering BWLW to a participant changed her life and well-being on a daily basis because she now knows not only how to properly use her medication but why it is important to use it regularly. Although we met our goal of recruiting 30 educators we did not met our goal of educating 300 adults -Where they’ve had a natural referral mechanism and partnerships in the community. -We are continuing to work with our educators to ensure that they reach their goals Recruitment and Implementation Challenges Lack of Physician by-in Patient resistance in areas of high poverty, poor health and low literacy Higher education priorities in health systems (e.g. COPD, diabetes, obesity)
2525
Program Impact on Patients
I’ve learned to help my family better manage asthma
The importance of cleaning nebulizers and spacers properly
Primary Goal for participating: Breathing
All the information Beth and the pharmacist gave us helped me learn to better control my asthma.
What to do about triggers and when to go to the ER.
Breathe Well, Live Well Evaluation
Presenter
Presentation Notes
Going through the process of becoming an educator was easy. The online training was easy to use, effective and completely flexible for doing it on my own time. The team at ALA is great to work with and very helpful. Ask questions – they want to help you be successful. If you wonder if adult patients really need the education, I can assure you, they do! We’ve been able to offer the courses in Spanish – this has been very effective. Have someone come to co-facilitate the program for registration and evaluation help. While the course metric documentation is easy to complete, keeping it all organized and fully executed can be challenging in a group setting. HOW YOU CAN HELP: Refer patients to ALA education Become an educator Get a grant to support education in your community Fundraise to support this vital program
2626
Breathe Well, Live Well Evaluation
Presenter
Presentation Notes
Here’s a little more of what participants had to say in their own words….
2727
Summary
• Find more information about Breathe Well, Live Well | Lung.org/breathe-well
• To get started please email [email protected]• https://www.youtube.com/watch?v=npLJCPcMlkU
Presenter
Presentation Notes
