EDUCATION PRINCIPLES
FOR A PARTNERSHIP IN
ASTHMA CARE
Learning strategies that contribute
to successful asthma management
Presented by :Christina Perry, PhD
This session will cover:
1. Need for effective patient education
2. Barriers to learning
3. Current educational concepts
a. Styles of learning
b. Age-appropriate teaching / learning strategies
c. Effective communication and interviewing skills
4. Selecting appropriate educational material
5. Health literacy
Activity: Barriers to Learning
Working in small groups:
1. Identify a recorder/reporter
2. Brainstorm to identify possible barriers to
learning
3. Be prepared to share your ideas
4. List all ideas on flip chart paper
No fair looking at your notes!
Barriers to Learning and Adherence
• Education level
• Understanding level:
material is inappropriate
or too complex
• Reading comprehension
• Hearing/Visual
impairment
• Language - English is a
second language
• Too much information at
one time
• Conflicting information
• Uncomfortable
environment
• Uninformed instructor
• Attitude of instructor
• Previous negative
experiences with
learning
Barriers to Learning for Adults
• Some patients have grown accustomed to the
limitations of uncontrolled asthma, help them
redefine what normal is.
• Teach your patients how to communicate with
health care professionals
• Adherence (Compliance) in the long-run
depends on early and continued success.
Patient Education
Current asthma management approaches require patients and families to:
EFFECTIVELY CARRY OUT COMPLEX
PHARMACOLOGIC REGIMENS
INSTITUTE ENVIRONMENTAL CONTROL
STRATEGIES
COMMUNICATE APPROPRIATELY WITH
HEALTH CARE PROVIDERS
DETECT AND SELF-TREAT MOST ASTHMA
EXACERBATIONS
Importance of Patient Education
• Mechanism through
which patients learn to
effectively manage their
asthma
• Powerful tool for
helping patients gain
the motivation, skill, and
confidence to control
their asthma
Starts with
“Needs
Assessment”
Tailored to
an individual
Improves
adherence
Begins at the
time of
diagnosis
Excellence in
Patient
Education
Establishes a
partnership
Systematic
(according to
a plan)
Integrated
with medical
care
Reinforces
critical
information
Opportunities for Education
ED/
HospitalBased
Education
Clinic/
ComputerBased
Technology
Home
Office
Based
Patient should
be educated at
multiple points
of care
Community
Based
School
Settings
Pharmacists
KEY CONCEPTS IN ASTHMA EDUCATION
Key Concepts in Asthma Education
Understand the basic facts about asthma
Define well-controlled asthma and current level of control
Recognize the roles of medications
Assess skills
Identify when and how to handle signs and symptoms of worsening asthma
Recognize when and where to seek care
Identify environmental exposure control measures
Education should be provided by all
members of the healthcare team
Teach asthma selfmanagement, tailoring the
approach to the needs of
each patient.
• Maintain a sensitivity to cultural beliefs and
practices.
Jointly develop
treatment goals.
• Provide all patients with a written treatment
plan, after discussing their needs.
Provide patients with
a daily asthma diary.
Key Concepts in Asthma Education
Teach and Reinforce at Every Opportunity
• Basic facts about asthma
• Roles of medications
• Skills: inhalers, spacers, self-monitoring
• Environmental control measures
• When and how to take rescue actions
Key Concepts in Asthma Education
Educational Efforts Should Be Continuous
• It may take up to six months for the impact of
education to be evident.
• It is necessary to periodically review information
and skills covered previously because patient selfmanagement behavior is likely to decline over time.
Turning Education into Action
For someone to effectively manage their asthma
they need to:
Take medications as
prescribed
• Use metered-dose inhalers, spacers, and nebulizers
correctly
Identify and control factors
that make asthma worse
Self-monitor to:
Follow the written action
plan when symptoms occur
• level of asthma control
• symptoms and, if prescribed, use peak flow
• early signs and symptoms of worsening asthma
Benefits of Self-Management Skills
• Reduction of urgent care visits and
hospitalizations
• Reduction of asthma-related health care costs
• Improvement in health status
LEARNING STYLES
Learning Styles
A learning style is the unique collection of
individual skills and preferences that affect how a
person perceives, gathers and processes
information.
Learning Styles
Learning styles affect how a person:
•
•
•
•
•
•
•
Acts in a group
Learns
Participates in activities
Relates to others
Solves problems
Teaches
Works
Three Main Learning Styles:
Visual
Auditory
Kinesthetic (Active)
Visual Learners
• Gather information best by looking, reading, and
watching
• May tune out spoken directions and favor
illustrated explanations or charts
• May take notes even when they have printed
notes on the desk in front of them
Auditory Learners
• Learn well by discussing ideas
• May learn better by being read written
information out loud
• Are easily distracted by noises
• Like background music to muffle interrupting
sounds
Kinesthetic (Active) Learners
• Learn effectively through
touch, movement and
space.
• Learn skills by imitation
and practice.
Learning Styles
People Learn Best If They See, Hear, and Do
• Verbal Explanations with Demonstration
• Use Examples and Analogies
• Provide Written Materials in Basic Language
• Ask For Return Demonstrations (e.g., correct use of
inhalers and peak flow meters)
Learning Styles
People Learn Best If They See, Hear, and Do
• Ask questions and LISTEN
• Encourage questions, and test their understanding
• End with “What else can I answer for you?” or “is
there anything else that concerns you?”
• Repeat key concepts in asthma education at each
visit to reinforce asthma management skills
COMMUNICATION SKILLS
COMMUNICATION IS CRITICAL
Encourage adherence:
•
•
•
•
promote open communication
individualize, review, and adjust plans as needed
emphasize goals and outcomes
encouraging family involvement
Document in the patient’s record:
• key educational points
• patient concerns
• actions the patient agrees to take
Promote Open Communication
Ask about patient
concerns early.
Adjust the plan as
needed.
Review the short-term
goals agreed upon
in the initial visit.
Review the action
plan and the steps the
patient was to take.
Teach and reinforce
key educational
messages.
Give patients simple,
brief written materials
that reinforce the
actions recommended
and skills taught.
Effective Interviewing Skills
• Show attentiveness (eye contact, attentive listening)
• Give nonverbal encouragement (nodding agreement,
smiling)
• Give verbal praise for effective management
strategies
• Use open-ended questions:
Instead of “Have you tried to
control the things that make
your asthma worse? If not,
why not?
Try: “What have you done to
control the things that make
your asthma worse?”
Use Effective Interviewing Skills To:
Assess Knowledge
• Identify what patient perceives as knowledge
relevant to his care
• Determine education, literacy level
• Determine ability (and readiness) to learn and
understand.
Take Time to Listen
Assess patients’ and/or caregivers’ perception
and beliefs about asthma and past experience:
• Belief in the severity and chronic nature of asthma
and the efficacy of treatment
• Regarding use and long-term effects of medications
• Capacity to recognize severity of an exacerbation
Areas for Educational Assessment
Knowledge
Motivation
Readiness to
Learn
Health Literacy
Education /
Understanding
Barriers
Goals
Non-verbal communication
• Is recognizable in the initial three seconds after
meeting someone for the first time.
• Can continue through the entire interaction.
• Accounts for approximately 70% of a
communication episode.
• Can impact the success of communication more
acutely than the spoken word.
Nonverbal Communication Skills
Voice
Facial Expression
Eye Contact
Posture
Gesture
TEACHING/LEARNING STRATEGIES
Attention Span
Information from: Pediatric Asthma Promoting
Best Practice: Guide for Managing Asthma in
Children. American Academy of Allergy, Asthma
& Immunology
Teaching / Learning Strategies
Deliver the information in a way that will be
easily understood and accepted.
• Deliver the information in several different ways
• Repeat the information often
• Use written material for reinforcement
• Be aware of literacy issues
Age-appropriate teaching strategies
For Preschool Children:
• Keep teaching sessions short (no more than 15
minutes)
– Schedule sessions close together
• Use small group sessions with peers help
• Use short, simple, direct messages
• Provide visual and physical stimuli, use bright bold
colors and pictures
• Use active learning techniques
– Allow to play-act with dolls and puppets
• Encourage child to participate in selecting between
teaching – learning options
Age-appropriate teaching strategies
For School-Aged Children:
• Use analogies to increase understanding
• Teach Skills
• Use materials showing peers dealing with similar
problems
• Provide opportunities for private instruction
• Provide opportunities for group interaction and
games
• Session can last for up to 30 minutes
– Spread sessions apart to allow for practice of new skills
• Provide support
Teaching Approaches for Children
Treatment issues include:
• Remembering to take medication
• Handling exercise induced problems
• Recognizing symptoms and requesting
treatment
• Avoiding triggers
– Involve the child as much as possible, including
development of the asthma plan.
Adherence (Compliance) Issues
For Teens:
• Medication use and teen lifestyle
• The need to conform vs. the need to avoid
triggers
– Social situations
– Physical activity
• Feeling of immortality
• Lack of understanding from others
Strategies for Teaching Teens
Adolescents should receive ALL information
Teens and young adults tend not to look after
themselves and rarely ask for help. This is the
result of four factors:
1. Independence
2. Rebellion
3. Peer Influence
4. Poor or non-compliance/adherence
Strategies for Teaching Teens
• Use one-on-one instruction when possible
• Respond best to peers
• Use group discussion with role-play and
interactive games
• Use problem solving activities
• Use various forms of visual educational tools
Strategies for Teaching Teens
• Clarify terminology
• Provide sincere, honest personal contact
• Treat them with respect, acknowledge their
feelings
• Empower them to make their own decisions and
to take responsibility for their own care
• Provide simple approaches to therapy
Strategies for Teaching Adults
Adults Learn Best When:
• Learning is related to an immediate need, problem
or deficit
• Learning is voluntary and self-regulated
• Learning is person-centered and problem-centered
• Learning is self-controlled and self-directed
• The role of the teacher is one of facilitator
• Information and assignments are pertinent
• New material draws on past experiences and is
related to something the learner already knows
Strategies for Teaching Adults
Adults Learn Best When:
• The threat to self is reduced to a minimum in the
educational situation
• The learner is able to participate actively in the
learning process
• The learner is able to learn in a group
• The nature of the learning activity changes
frequently
• Learning is reinforced by application and prompt
feedback.
Source: Nurse as Educator: Principles of
Teaching and Learning
Strategies for Teaching Adults
• Build on and incorporate their experiences into
their education plan.
• Present factual information that can help them
make decisions and they prefer self-direction.
Older Adults
• Alterations in physiological
functioning can lead secondarily
to changes in learning ability
– Slower processing time
Older adults
– Persistence of stimulus (afterimage) constitute
• Confuse a previous symbol or work
with a new one
– Decreased short-term memory
– Increased test anxiety – anxious
about making mistakes
– Altered time perception
• I’ll worry about that tomorrow
approximately 12%
of the US population.
By 2030, this
number is expected
to increase to 21%.
Teaching Strategies for Older Adults
• Compensate for visual changes
– Environment that is well-lit
– Visual Aids in large print, well spaced
– Avoid blue, blue-green and violet hues
• Compensate for hearing loss
– Eliminate extra noise
– Speak face to face
• Short sessions with frequent breaks
• Check psychomotor skills
• Allow increased time to process and react to
information
Teaching Strategies for all ages
• Teach Problem Solving Skills
• Define problem in behavioral terms
• Divide stressful events into smaller, manageable
tasks
• View “failure” as learning via feedback
• Generate & evaluate solutions
• Make contingency plans
HEALTH LITERACY
Low Literacy
Key Messages:
• Assess understanding at every opportunity.
• Enlist family members or volunteers to help.
If low-literacy is suspected, tell the
patient, “Many people have trouble
reading and remembering these
materials.”
Ask, “is that a problem for you?”
Health Literacy
Health literacy refers to the ability to read,
understand, and act on health information:
• A 1999 report from the American Medical Association (AMA),
points out that, “Poor literacy is a national crisis… almost half
our adult population has basic deficiencies in reading,
computational skills, or English.”
• The AMA reports that low health literacy is a major cause of
rehospitalization and other complications among the elderly,
the group that uses medical services most often; the decline in
health literacy occurs regardless of education level.
Functional Health Literacy
One-third of English-speaking patients at two public
hospitals could not read and understand basic healthrelated materials:
• Overall, 42% of patients were unable to comprehend
directions for taking medication on an empty
stomach
• 26% could not understand information on an
appointment slip
• 60% could not understand a standard consent form
Williams MV, Parker RM, Baker DW, et al, Inadequate functional
health literacy among patients at 2 public hospitals. JAMA.
1995; 274: 1677-1682.
Health Literacy
• People with low literacy, language barriers, lack of
education, or the elderly or poor often face the most
challenges in practicing healthy behaviors and
navigating the healthcare system.
• However, even highly educated people when faced
with a disturbing diagnosis, a chronic disease, or
the anxiety associated with an unexplained pain
can be affected by health illiteracy.
The Rhode Island health Literacy Project
http://www.rihlp.org/index.cfm
DESIGNING PATIENT EDUCATION
MATERIALS
Designing Patient Education Materials
People at all literacy levels prefer simple
materials
• Supplement text with pictures or diagrams
• Reading level should be no higher than 5th grade.
• Put most important information first and separate from
the text.
• Use clear captions and ample white space
• Use short, simple words and common terms whenever
possible (for example “cut” instead of laceration).
• Define medical or insurance terms in simple language.
Designing Patient Education Materials
• Emphasize the desired behavior (call to action),
rather than the medical facts. Use examples.
• Limit to one or two educational objectives.
• Use personal pronouns such as “you” and “your.”
• Be culturally inclusive with text and graphics.
Address the cultural and ethnic diversity of the
target audience.
Readability Formulas
• SMOG uses 30 sentences and the number of
words with three or more syllables.
• FOG uses the number of word per sentence and
the number of words with three syllables or
more.
• Flesch Formula uses average sentence length in
selected samples of 100 words.
All of these indicate reading ease and not
comprehension.
Educational Resources
• Written materials and formal education programs
can supplement, but not replace patient
education provided in the office.
• Patients may benefit from a formal asthma
education program that has been evaluated and
reported in the literature to be effective.
http://www.cdc.gov/asthma/interventions/children.htm#schools
Open Airways for Schools: 1-800-LUNG-USA
Asthma Care Training (ACT) for Kids: 1-800-7-ASTHMA
Creating a Medical Home for Asthma:
http://www.nyc.gov/html/doh/html/cmha/index.html.
Selecting Patient Education Materials
All materials should be evaluated before you use
them for teaching.
Materials must be:
• From a reliable source
• Accurate
• Culturally relevant
• Current
• Written at the appropriate educational level
References
American Academy of Allergy, Asthma and Immunology.
Pediatric Asthma Promoting Best Practice – Guide for
Managing Asthma in Children. 1999.
Global Initiative for Asthma. Global Strategy for Asthma
Management and Prevention. NHLBI/WHO Workshop
Report.
American Association for Respiratory Care. Clinical Practice
Guideline:Providing Patient and Caregiver Training.
Respiratory Care 1996; 41(7):658-663
National Asthma Education and Prevention Program Task Force
on the Cost Effectiveness, Quality of Care, and Financing of
Asthma Care. National Institutes of Health, 1996
Better Communication, Better Care: Provider Tools to Care for
Diverse Populations. Health Industry Collaboration Effort
(ICE).
Acknowledgements
• Lori Kondas
American Lung Association in Ohio
• Michelle Mercure, CHES
American Lung Association in Wisconsin
We will breathe easier when the air in every
American community is clean and healthy.
We will breathe easier when people are free from the addictive
grip of cigarettes and the debilitating effects of lung disease.
We will breathe easier when the air in our public spaces and
workplaces is clear of secondhand smoke.
We will breathe easier when children no longer
battle airborne poisons or fear an asthma attack.
Until then, we are fighting for air.