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Rapid Evaluation
Coordinated School Health Program for Asthma in Charlotte Mecklenburg Schools
Public Health Problem
Asthma is a serious problem for our nation’s children.
- More than 5 million school-aged youth have asthma.
- Asthma is the leading cause of school absences resulting from a chronic illness,
accounting for almost 8 days of missed school for each student with asthma, and more
hospitalizations than any other childhood disease.
- The death rate for children younger than 19 years of age has increased by nearly
80% since 1980.
Initiative Description
To address the needs of children with asthma, Charlotte-Mecklenburg Schools (CMS)
established an asthma program in 2002. The program includes five key components that
reach both the student and school levels. Student-level components include
- Case management of students with asthma provided by the school nurse
- Respiratory therapy provided by professional respiratory therapists for students
with asthma
- Open Airways for Schools, an asthma education curriculum for 3rd–5th grade
students with asthma
School-level components include
- Staff development and education
- School health teams with a focus on asthma
Evaluation
In 2007–2008, 12 elementary schools and 2 high schools participated in the evaluation.
Data were collected from 234 elementary school students using paper-and-pencil questionnaires
about asthma management behaviors (e.g., appropriate use of inhalers, peak flow meters,
or spacers), self-efficacy (i.e., students’ certainty they could perform asthma management
behaviors), and difficulties (e.g., waking up at night or going to the hospital because
of asthma). Additional qualitative data were gathered through interviews with 41 district
and asthma program staff and focus groups with 16 parents, 54 elementary school students,
and 26 high school students. For quantitative analysis, each student was categorized as
having a low, medium, or high level of need for intervention based on the higher of two
scores: 1) nurse’s rating of level of need based on perception of control, clinical
indicators, and lack of resources and/or health care providers, or 2) students’ responses
to items on the questionnaire related to asthma management difficulties.
Findings
Evaluation results revealed
- Approximately half of the students with medium or high levels of need for the intervention were formally enrolled in at least one student-level component of the program.
- At posttest, students who received at least one student-level component of the asthma program demonstrated higher asthma management self-efficacy than students not enrolled in any student-level component.
- Medium- and high-need students who received at least one student-level component of the asthma program demonstrated improvement in asthma management difficulties from pretest to posttest.
- Twenty-six percent of students reported that they could always get to their inhalers quickly during the school day.
- Elementary school students who were exposed to environmental tobacco smoke (ETS) reported significantly higher levels of asthma management difficulties than students not exposed to ETS. In addition, exposure to ETS was commonly reported by high school students with asthma.
Implications
CMS is using the evaluation findings to improve their program. Specifically, asthma
program staff plan to re-examine the ways students are selected for asthma program services;
better market the district’s policy allowing self-carry and self-administration of asthma
medications; and integrate smoking cessation classes into their current system for providing
parent education.
Sample Tools and Instruments
This section contains selected data collection tools and instruments that were used
in this project. These sample instruments are posted as examples to guide development of
instruments for other projects, but are not intended to be used in their current form,
as they have been tailored to address specific evaluation questions of interest to
Charlotte-Mecklenburg Schools.
Asthma Survey for Elementary School Students
[doc 178K]
Questionnaire for students in grades 3, 4, and 5 to assess asthma management self-efficacy,
asthma management difficulties, and asthma management behavior.
Program Component Checklist for Nurses
[doc 115K]
Questionnaire for nurses to assess the asthma management activities at their schools including
case management, asthma education, respiratory therapy services, staff development, and
involvement of the school health team.
Focus Group Guides
Guides for 60-minute focus groups with students and parents on asthma education and
services provided at school.
-
Elementary School Parent Focus Group [doc 254K]
Guides discussion among parents of students with asthma on students’ asthma-related
education and services in the school, perceptions of the impact of asthma on students’
school performance, and school support for students’ asthma.
-
Elementary School Student Focus Group [doc 254K]
Guides discussion on asthma symptoms, asthma management behaviors, access to rescue medications
at school, and perceived school performance and support.
-
High School Student Focus Group [doc 256K]
Guides discussion on asthma symptoms, asthma management behaviors, access to rescue medications
at school, asthma education, and perceived school performance and support.
Interview Guides
Guides for 20- to 60-minute interviews for individuals involved in asthma-management
activities in schools, including the following:
Guides include questions about
- Students with asthma
- Current asthma management practices
- Experiences of students with asthma
- Steps taken to reduce or eliminate environmental asthma triggers
- Education for students with asthma
- Barriers and facilitators to the provision of asthma management services
- Case management
- The role of program champions
For More Information
Additional information about this rapid evaluation, including the full evaluation report,
is available from
Charlotte-Mecklenburg Schools. Related publications are listed on the
Publications page.
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