Dr Smita ShahDr Smita Shah

DirectorDirectorPrimary Health Care Education & Primary Health Care Education & Research UnitResearch UnitSydney West Area Health Service Sydney West Area Health Service Senior Clinical Lecturer Senior Clinical Lecturer University of Sydney University of Sydney AustraliaAustraliaSmita_shah@wsahs.nsw.gov.auSmita_shah@wsahs.nsw.gov.au

Initiatives and Community Approaches

Asthma in a Small World

Prevalence of Asthma in Australia Prevalence of Asthma in Australia

Adolescent Asthma

1 in 6 adolescents

43% had asthma attacks

22% had severe limitation

22% smoked

78% missed school

1

2

3

4

PG Gibson et al, 1998

Triple A ProgramTriple A Program

Peer-ledPeer-led Entrusts young people to take the Entrusts young people to take the

health messageshealth messages Based on psycho-social theory Based on psycho-social theory Structured programStructured program Triple A Program Resource kit Triple A Program Resource kit Asthma Friendly Schools Asthma Friendly Schools

Program Program

Medical Students Train as AAA Medical Students Train as AAA Educators Educators

Step 1: Training Asthma Peer Step 1: Training Asthma Peer LeadersLeaders

Take your medication before exercise

Step 2: Peer-led lessons

“Take that cancer stick away”

Step 3:Step 3: Asthma Skits Asthma Skits

Does it work?Does it work?

Program tested in a large randomised Program tested in a large randomised controlled trial ( n = 1379) controlled trial ( n = 1379)

Improvements in: Quality of LifeQuality of Life School absenteeismSchool absenteeism Asthma attacks at schoolAsthma attacks at school Participant satisfactionParticipant satisfaction

Shah et al., BMJ 2001, Boulet et al., Evidence Based Medicine 2001Shah et al., BMJ 2001, Boulet et al., Evidence Based Medicine 2001

% of Students with QoL improvement

0 10 20 30 40 50 60

Emotions

Symptoms

Activities

Total

% of Students

Control

Intervention

Asthma Attacks

0

5

10

15

20

25

30

35

40

45

50

Control Intervention

% o

f Yea

r 10

Stu

dent

s

Baseline

Post AAA

*

21.2 34.8 24.2 25.8

School Absenteeism

0

2

4

6

8

10

12

Control Intervention

Med

ian

(d

ays)

Baseline

Post AAA

5.5 4 8 5

*

Comments from Peer Leaders

Gained leadership skills and felt proud that I got the message across

Knowing what to do if an asthma attack occurs

How to help people with asthma

Don’t smoke if you have asthma

Organisational skills and the confidence to teach

Parents & School Staff

Parents““It’s great to see teenagers taking responsibility for their health”It’s great to see teenagers taking responsibility for their health”

“ …“ …. has become better at managing her asthma”. has become better at managing her asthma”

“ “ Should be a regular program in the school”Should be a regular program in the school”

Teachers

““Students are no longer embarrassed to take their medications at Students are no longer embarrassed to take their medications at school” school”

““We no longer have emergencies at school”We no longer have emergencies at school”

“ “ Benefits for the peer leaders were enormous” Benefits for the peer leaders were enormous”

“ “ Reduction in smoking”Reduction in smoking”

SummarySummary

Triple A Program Improves QoLImproves QoL Reduces asthma attacks and school absenteeismReduces asthma attacks and school absenteeism Seen as beneficial by young people themselvesSeen as beneficial by young people themselves Sustainable Sustainable Currently being trialed in USA (and Jordan)Currently being trialed in USA (and Jordan) Resources soon available on Asthma Foundation of Victoria website Resources soon available on Asthma Foundation of Victoria website

(www.asthma.org) (www.asthma.org) Funding thanks to the Australian Government Department of Health Funding thanks to the Australian Government Department of Health

and Ageing and Ageing

Triple A and Aboriginal Triple A and Aboriginal ChildrenChildren

Hard to reach populationHard to reach population

Can reache large numbersCan reache large numbers

EmpoweringEmpowering

Beneficial for all involvedBeneficial for all involved

Promotes local leadership Promotes local leadership

Better communication skillsBetter communication skills

“We got so much out of this program - and now my daughter plays netball and athletics and state championships and won a bronze medal for 700 meters”

Works for us – works for you

Questions

Sydney Opera House & Harbor Bridge