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Identifying Asthma Patient Education Materials that Support National Heart, Lung and Blood Institute Guidelines* FREE TO VIEW

James B. Fink, MS, RRT
Author and Funding Information

*From the Department of Medicine, Loyola University, Chicago, IL.

Correspondence to: James B. Fink, MS, RRT, Administrative Analyst, Medical Services, Hines VA Hospital, Box 5000 (111), Hines, IL 60141; e-mail: james.fink@med.va.gov

Chest. 1999;116(suppl_2):195S-196S. doi:10.1378/chest.116.suppl_2.195S
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In its role as a clearinghouse for high-quality information about asthma, the Chicago Asthma Consortium (CAC) realized that although there was a great deal of literature designed for patient education on asthma, there were no ready standards for differentiating the material’s ability to present and reinforce essential factors for appropriate management. Since the National Heart, Lung and Blood Institute (NHLBI) guidelines for asthma care were first published in 1991, health-care organizations have encouraged adoption of the asthma management and patient education strategies nationwide. Materials are available from a wide variety of sources, including pharmaceutical companies, public organizations, and individual institutions. However, most clinicians are faced with a limited subset of teaching materials and no means to evaluate the quality of the information.

As such, the patient and public education committee of the CAC was charged with conducting a thorough review of the patient education materials currently available to the CAC membership. At the request of the CAC, 236 members submitted their patient education asthma materials for review. It was the committee’s task to determine which of the educational materials effectively incorporated the key elements of the NHLBI guidelines. The ultimate goal was to develop a comprehensive list of appropriate teaching materials that CAC members might use to augment their patient education efforts.

The committee consisted of over 60 members, approximately 15 to 20 of whom attended any monthly meeting. The committee used a modified Delphi technique to identify critical components of the materials that support the national asthma guidelines. They began with a review of the NHLBI guidelines, listing each of the key elements or teaching points. During a period of 6 months and through more than 20 revisions, the committee identified 135 key elements that were then incorporated into a 28-item evaluation tool. Each of the items was to be rated on a scale of 1 (topic not covered) to 5 (exceeds criteria). An item had to receive a rating of > 2.5 to meet the CAC standard of “acceptable.”

Armed with this new tool, 14 committee members, well-versed in the intent of the tool, rated 133 different asthma education materials, each of which was reviewed by at least two members. As the completed evaluations were tallied, materials with widely disparate ratings underwent a third review. Amazingly, the scores of the reviewer pairs were within 20% of each other.

Of the 133 materials reviewed, only the NHLBI guidelines themselves met all of the criteria as determined by the committee. Based on these findings, the committee was concerned that they might have set too high a standard, and raised the question of whether all criteria should be given equal weight. They concurred that it was possible to identify a subset of 10 items that they believed were critical in meeting minimal acceptable standards. When they applied this new subset of criteria, 21 of the patient education materials met minimum acceptable standards.

The committee members were surprised to find that 6 years after the release of the national asthma education guidelines, relatively few of the materials available from advocacy groups, clinicians, or industry effectively taught the key elements of the guidelines.

They believed that they should not only share their findings with the consortium members, but also offer feedback to other interested organizations. To that end, the committee now offers members and interested parties technical assistance in reviewing their asthma education materials. The committee identifies both strengths and key topic-area deficiencies in existing materials in an effort to promote the development of comprehensive materials and teaching programs for patients, families, and providers.

Since the development of the evaluation tool, several organizations, notably the American Red Cross and the American College of Chest Physicians, have used the committee’s services to modify and develop materials that include all of the key criteria. The committee has also modified the evaluation tool to address single-topic brochures, and will be modifying the criteria to include video materials and program teaching plans.

In conclusion, although many asthma patient education materials endorse the national guidelines, none of the materials supported all 28 key areas of the guidelines. Since this initial effort, new materials have been developed, and several additional companies and organizations have approached the committee for technical assistance in the development of their new or revised materials. The CAC committee on patient and public education hopes that both providers and patients will benefit from selecting asthma education materials that support the national guidelines.

Abbreviations: CAC = Chicago Asthma Consortium; NHLBI = National Heart, Lung and Blood Institute

This manuscript describes an activity of the Chicago Asthma Consortium that was funded by a grant from the Otho S.A. Sprague Memorial Institute.




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