Student Pharmacists as Pediatric Asthma Educators

by Caroline Adrian, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Review and Summary of: Elliott JP, Marcotullio N, Skoner DP, et al. Impact of student pharmacist-delivered asthma education on child and caregiver knowledge. Am J Pharm Educ. 2014 Dec 15;78(10):188.

 As a student pharmacist, I recognize the importance of medication adherence in the management of chronic conditions. However, when I was diagnosed with asthma as a child, I did not understand the concept of maintenance therapy. I didn't understand that I needed to use my inhaled corticosteroid every day to prevent exacerbations. Frankly, I didn't even know what that inhaler was for, so I frequently missed doses. Looking back, I wish someone had taken the time to educate me about asthma and the medications I needed to use so I might have had better symptom control. I recently discovered a study¹ that looked at the impact of student pharmacists as asthma educators to both children and their caregivers. I was eager to learn more.

This cross-sectional study enrolled children and caregivers who attended at least 1 of 6 For Your Good Health, LLC asthma camps at Duquesne University over a two year period. The asthma camp series was developed to teach children, ages 5-17 years, and their caregivers asthma self-management skills. The camps were directed by an interdisciplinary team of physicians and pharmacists and staffed by student pharmacists and university athletes. Camps were held on Saturdays from 9:00 am to 2:00 pm, with asthma screenings and education being conducted during the morning session. The primary objective was to evaluate the impact of student pharmacist-delivered asthma education on child and caregiver knowledge about asthma. The secondary objective was to assess child and caregiver baseline asthma knowledge and its correlation with asthma control.

The hands-on educational activities implemented at each asthma camp were developed by sixth-year Doctor of Pharmacy students under the guidance of two faculty members. The activities focused on the 4 key components of effective asthma management: avoidance of triggers, medication compliance, proper inhaler technique, and the importance of an asthma action plan. Some of the activities included interactive skits to teach proper inhaler technique, game shows highlighting the differences between controller and reliever medication, and a memory game of asthma triggers. One group of students built a large cardboard house that contained common asthma triggers for their activity. They worked with the children to make the house more "asthma-friendly," discussing how to limit exposure to each of the triggers. Caregivers were not required but strongly encouraged to attend with their children.  The participants rotated through 4 stations of activities that lasted up to 15 minutes each. 

An asthma knowledge questionnaire was administered separately to the children and to the caregivers at the beginning and end of each asthma camp to assess the effectiveness of the educational program. Of the 87 children enrolled in the study, 76 completed both the pre- and post-intervention questionnaires. Only 45 caregivers participated in the educational intervention with 42 completing the pre- and post-intervention questionnaires. Statistical analyses compared the pre and post-intervention scores. 

The study found that the asthma education program was effective in increasing asthma knowledge among children. However, the student pharmacist-delivered education was not effective in increasing asthma knowledge among caregivers. Many of the caregivers who participated did not have children with asthma and the investigators also noted that many caregivers opted to socialize amongst themselves rather than participate in the educational components of the For Your Good Life camp. It was unclear to me whether the investigators designed the educational intervention with the caregivers in mind, or if they designed the intervention to focus on the children alone with hopes that the caregivers would be willing to participate. It seems the educational intervention was engaging for the children but perhaps not of great interest to adults. However, the investigators found a strong association between caregiver pre-intervention scores and asthma control in their children, suggesting that caregiver knowledge of asthma plays a role in asthma control.

This study found that the educational program was beneficial to the children who participated as well as the student pharmacists. The student pharmacists were able to practice their role as future educators by developing and implementing novel educational activities. A weakness of this study was that the investigators used different student pharmacists at the camps and this may have led to differences in how the educational activities were conducted. A limitation of this type of educational intervention is that the development and implementation of such a camp requires a significant amount of time and resources.

This was the first study to assess the effectiveness of student pharmacists as asthma educators in a pediatric population. Other studies have shown student pharmacists can effectively educate adults with chronic illness.^2,3 Other studies have found that asthma education of children and caregivers can lead to better symptom management and fewer acute exacerbations,⁴ and educational programs for asthma self-management in children alone can also lead to improved lung function and fewer trips to the emergency department.⁵

This is a great way for educators to engage student pharmacists to conduct hands-on learning experiences teaching children about asthma. Similarly, structured learning activities may be beneficial in teaching children about other disease states as well. Diabetes and epilepsy are also common chronic conditions in children where student pharmacists can assist in delivering fun educational programs to kids. 

References:

1. Elliott JP, Marcotullio N, Skoner DP, et al. Impact of student pharmacist-delivered asthma education on child and caregiver knowledge. Am J Pharm Educ. 2014 Dec 15;78(10):188.
2. Letassy N, Dennis V, Lyons TJ, et al. Know your diabetes risk project: Student pharmacists educating adults about diabetes risk in a community pharmacy setting. J Am Pharm Assoc (2003). 2010 Mar-Apr 1;50(2):188-94.
3. Shrader S, Kavanagh K, Thompson A. A diabetes self-management education class taught by pharmacy students. Am J Pharm Educ. 2012 Feb 10;76(1):13.
4. Agusala V, Vij P, Agusala V, et al. Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas. J Int Med Res. 2018 Aug;46(8):3172-3182.
5. Guevara JP, Wolf FM, Grum CM, et al. Effects of educational interventions for self-management of asthma in children and adolescents: systematic review and meta-analysis. BMJ. 2003 Jun 14;326(7402):1308-9.