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The Roaring Adventures of Puff (RAP): A Childhood Asthma Education Program

Implemented in Edmonton, Alberta, Canada by MAS Consultants Inc., P.O. Box 5130 Aiken, South Carolina 29804.

The Roaring Adventures of Puff (RAP): Operation of Replicated Program

Once parental consent is received, the Capital Health instructor coordinates the timing and delivery of the educational sessions. At the beginning of class, the children are given a RAP Fun Book (child’s workbook) that contains asthma information paralleling the instruction provided each week in class. The students are asked to accomplish certain tasks each week that promote better asthma management. The children take the workbook home to complete the exercises and to discuss with their parents what they learned in class that week. The parents sign the workbook, indicating that they discussed that week’s topic with the children. Each week the children bring their Fun Books to class, they receive recognition for the completed assignment.

The parents are invited to attend the sixth session. They hear from the children what the children have learned about how to control their asthma and participate in fun learning activities associated with their children’s learning. The children prepare presentations for their parents; these presentations might be a poem, a completed piece of art, a skit, or a song. Each child who brings his/her Fun Book to class each week receives recognition and a little prize. Session six also celebrates successful completion of the class, and each child receives a certificate of course completion.


RAP is offered as a series of six 30- to 40-minute group sessions. These are held each week at the same location within the school and on the same day and always during the lunch hour. Children are reminded of their asthma class over the public address system just before the lunch break. Children eat their lunch while attending the session. All children in grades 1-6 meet together. The children come to realize, at times for the first time, that they are not alone in living with asthma. The sessions are open and interactive. The children are encouraged to ask questions often and to comment regularly about what they are learning and how they can use this information to better control their asthma.

At each session, the children are introduced to a new asthma subject, they do some activity designed to help them understand how to apply the information they have just learned, and they have a homework assignment from the Fun Book to reinforce their applied learning. Puff the dinosaur is an 18-inch tall puppet, operated by the instructor, who interacts with the children and keeps the learning fun, especially for younger children. Puff introduces the children to new asthma topics and reminds them of the importance of avoiding asthma triggers and taking their medicines. Puff appears as a cartoon narrator in the children’s Fun Book.

The Puff puppet scenarios are more likely used in class when the majority of the children are third-graders and under. Some instructors use Puff as a mascot rather than as an instructive puppet, which is more acceptable to older children. Other instructors use Puff as a role play tool for the children, allowing them to operate the puppet in puppet shows or discussions.

Instructor Training

The Alberta Asthma Centre provides the required instructor training for all RAP instructors, including those from Capital Health. This Childhood Asthma Education Workshop is 16 hours of instruction. On day 1, attendees receive an overview of the RAP program and the instructor’s manual; review the asthma management guidelines, asthma devices, asthma management issues in schools, and childhood education strategies; and work through situational case studies involving children with asthma. On day 2, participants learn tips for using puppetry and organizing RAP in the community, and they observe a demonstration of a RAP session. In the afternoon, attendees are paired and practice delivering a 10- to 15-minute asthma learning activity that is role-played later that afternoon. Each participant’s presentation is evaluated, and they take a quiz at the end of the day.

Program Funding

Capital Health pays for administering RAP (Table 3).

Table 3: Costs* of administering the six-session RAP in urban and rural areas of Edmonton, Alberta
Program Delivery CostsUrbanRural
1. Liaison with school health nurse, time 1 hour.$35.40$35.40
2. Contact school to setup program, time 3 hrs.$106.00


3. Phone contact with parents, time 4 hours$141.00$141.00
4. Pre-program administration, time 2 hours$70.80$70.80
5. RAP Fun Book and Action Plan Diary, $6/child$72.00$72.00
6. Program completion certificates, $3 each$36.00$36.00
7. Prizes, airway model supplies, $6/class$6.00$6.00
8. Instructor class time (6 hours)$212.40$212.40
9. Instructor driving time, average 1 hour for a urban delivery and 2 hours for a rural delivery$35.40$70.80
10.Mileage, at 32 cents/Km$12.80$51.20
Total $728.40 $802.20

*Canadian dollars (currently $0.70 US) 1 Km =5/8 mile. Gasoline in Canada is more expensive than in the United States.

Program Evaluation

A "smile sheet" questionnaire about how the child enjoyed the class is the only instrument used to evaluate the program.

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