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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 [email protected][email protected]
Initiatives and Community Approaches
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Asthma in a Small World
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Prevalence of Asthma in Australia Prevalence of Asthma in Australia
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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
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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
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Medical Students Train as AAA Medical Students Train as AAA Educators Educators
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Step 1: Training Asthma Peer Step 1: Training Asthma Peer LeadersLeaders
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Take your medication before exercise
Step 2: Peer-led lessons
“Take that cancer stick away”
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Step 3:Step 3: Asthma Skits Asthma Skits
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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
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% of Students with QoL improvement
0 10 20 30 40 50 60
Emotions
Symptoms
Activities
Total
% of Students
Control
Intervention
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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
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School Absenteeism
0
2
4
6
8
10
12
Control Intervention
Med
ian
(d
ays)
Baseline
Post AAA
5.5 4 8 5
*
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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
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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”
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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
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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”
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Works for us – works for you
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Questions
Sydney Opera House & Harbor Bridge