Report on the Asthma Society’s 2016 Asthma Education Programme for Socially Excluded Groups

Introduction – Initial Asthma Society Pilot Outreach Programme

A 2014 TCD evaluation of the Asthma Society’s pilot asthma education programme for traveller healthcare workers complimented its ‘train the trainer’ approach and noted that:

“[t]his approach is suitable for use with other marginalised groups subject to local commitment and cultural adaptation”.

It also made the following positive findings about the pilot programme:

  • There was an overwhelmingly positive response to the programme and the stakeholders, facilitators and the participants generally found it difficult to fault the programme.
  • The participants reported that their knowledge levels with regard to all aspects of asthma and its management had increased tremendously since attending the programme.
  • Generally, the participants felt confident in their ability to teach other health care workers about what they had learned during the programme.
  • Many of the participants had already started to educate other health care workers and they spoke enthusiastically and positively about this process.
  • This ‘Train the Trainer’ approach has been shown to be an effective, transferable and cost effective strategy to building capacity to outreach specialist asthma education to a wider population and is particularly suitable for use with disadvantaged and hard to reach groups.

Adaptation of this programme for deliveryto Outreach Workers in Rialto in 2015

Building on the TCD evaluation’s finding that the type of model used for the traveller health worker training is suitable for other marginalised groups, the Asthma Society developed a three week pilot programme for outreach workers in areas with high levels of socio-economic disadvantage.

With the kind support of the HSE National Office for Social Inclusion this pilot programme was delivered to seven outreach workers in the Rialto area of Dublin in November 2015.

Roll out of the programme to other disadvantaged areas in 2016

Following an evaluation of this pilot programme, it was proposed that a similar programme be delivered in four regions across Ireland from September to December 2016.

HSE structures were used to identify four regions in which to deliver the programme:

  • Limerick, in partnership with HSE Limerick Drug and Alcohol Service
  • Dublin 8, in partnership with Depaul
  • Dublin 15, in partnership with Coolmine Therapetic Centre, and
  • Cork, in partnership with Cork and Kerry Social Inclusion Services.

The programme was delivered in Limerick and the two areas in Dublin in 2016. Delivery in Cork was postponed until early 2017 due to unforeseen circumstances.

Funding received from the HSE National Office for Social Inclusion:

2015 / 2016
Funding Received / €16,481 / €34,564

The programme originally consisted of three half days (3 x 3 hours). However, following feedback from the groups, this was changed to two longer days ( 2 x 4.5 hours). The training in each location was delivered by a specialist asthma/ respiratory nurse. In total, 22 outreach workers received asthma education training in 2016. A further group will complete training in Cork in April 2017. Please see details below:

Location / Dates / No. of outreach workers trained
Limerick / 15th Nov & 6th Dec 2016 / 7
Depaul (Dublin 8) / 21st Nov & 5th Dec 2016 / 12
Coolmine TC (Dublin 15) / 24th Nov & 8th Dec 2016 / 3
Cork / Taking place on 31st March & 28th April 2017 / TBC

Profile Of The Participants

19 of the participants were female and three were male. The majority (20) were White/Caucasian with only two Black African participants. The level of education of participants varied from FETAC level 4/5/6 to higher certs, diplomas and degrees. The age range of participants ranged from 26 to 55 years. The participants reported delivering health education to 666 people.

Pre/Post Questionnaires

All participants received pre- and post-training questionnaires to assess their needs and their learnings from the programme. The findings of the questionnaires indicated participants had significantly improved their knowledge around asthma following the training. They were also more confident they knew what steps to take to help someone having an asthma attack.

Evaluation of the Programme

On the final day of training, the participants completed an evaluation form. All participants provided positive feedback for the programme. Theyagreed the topics covered were interesting and the trainer explained the topics clearly.

The majority ofparticipants commented that the most enjoyable part of the training was the hands-on inhaler technique workshop. Others commented that the resource packs provided would be very useful. With regards to the ‘elements of the programme they least enjoyed’, some participants suggested that the course was too long and should be condensed to one day. However, the majority of participants enjoyed all aspects of the training.

Further comments from participants included:

“I really enjoyed the training and found the topics very relevant in my career”

“Excellent trainer, practice aids were excellent”

“A really interesting course”

“Excellent course delivered very well”

2017 Plans

The TCD evaluation of the original traveller asthma education programme in 2014 highlighted the importance of refresher training. The Asthma Societytherefore intends to deliver refresher training to the 2016 participants of this programme in late 2017.

Follow-up support provided by the Asthma Society

Significant follow-up support is offered to all participants in the programme by the Asthma Society. Participants are given packs of materials to use with families and invited to contact the Society if they need more. They are also encouraged to use the Society’s online resources, such as its instructional videos on the correct use of different types of inhalers and devices.

The Society’s health promotion team offers ongoing phone and email support, including advice on how to deliver key asthma management messages to families and communities. Participants are also encouraged to speak with one of the asthma specialist nurses on the Asthma Society’s Adviceline if they, or one of the families they work with, need further information or advice.

Conclusion

While asthma cannot be cured, it can be controlled. With proper treatment and medication, people with asthma can live full lives, symptom free. However, 60% of Irish asthmatics do not have their condition under control. As a result, they are at risk of a serious attack, and even death, at any time.

Asthma is the most common chronic disease in Ireland, affecting one in five children. On average, children with asthma miss 10 school days every year as a result of their condition. Adults miss an average of 12 days of work per annum.

While achieving good asthma control is a challenge for many Irish adults and children, those from socio-disadvantaged areas face particular difficulties as a result of factors such as health inequalities, poor housing standards and exposure to higher levels of psychosocial stress. Such groups can also be hard to reach with health education messages.

With the kind support of the HSE National Office for Social Inclusion, the Asthma Society is helping to improve asthma management among this vulnerable group by equipping outreach workers with the information and skills they need to educate and support people with asthma in their area.

The programme has been positively evaluated by participants and is a good example of how targeted interventions can improve health outcomes among disadvantaged groups.

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