Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

천식 환아와 보호자를 대상으로 한 집중 교육 프로그램의 효과

Effects of an intensive asthma education program on asthmatic children and their caregivers

  • 서강진 (고려대학교 의과대학 소아과학교실) ;
  • 김건하 (고려대학교 의과대학 소아과학교실) ;
  • 유병근 (고려대학교 의과대학 소아과학교실) ;
  • 여윤구 (고려대학교 의과대학 소아과학교실) ;
  • 김종훈 (고려대학교 의과대학 의학과) ;
  • 심으뜸 (고려대학교 의과대학 의학과) ;
  • 윤미리 (고려대학교 의과대학 의학과) ;
  • 유영 (고려대학교 의과대학 소아과학교실) ;
  • 정지태 (고려대학교 의과대학 소아과학교실)
  • Seo, Kang Jin (Department of Pediatrics, College of Medicine, Korea University) ;
  • Kim, Gun Ha (Department of Pediatrics, College of Medicine, Korea University) ;
  • Yu, Byung Keun (Department of Pediatrics, College of Medicine, Korea University) ;
  • Yeo, Yun Ku (Department of Pediatrics, College of Medicine, Korea University) ;
  • Kim, Jong Hoon (Department of Medical School, College of Medicine, Korea University) ;
  • Shim, Eu Ddeum (Department of Medical School, College of Medicine, Korea University) ;
  • Yoon, Mi Ri (Department of Medical School, College of Medicine, Korea University) ;
  • Yoo, Young (Department of Pediatrics, College of Medicine, Korea University,) ;
  • Choung, Ji Tae (Department of Pediatrics, College of Medicine, Korea University)
  • 투고 : 2007.09.10
  • 심사 : 2007.10.13
  • 발행 : 2008.02.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 천식은 만성적인 질환으로 일상생활에서 적절한 치료와 관리를 수행하는 것이 매우 중요하며 이를 위해서는 천식 환아와 보호자 모두의 노력이 필요하다. 이에 천식 환아와 보호자를 대상으로 천식 교육 프로그램을 실시하여 그 효과를 평가해 보고자 하였다. 방 법 : 고려대학교 안암병원 소아 알레르기 클리닉에서 천식으로 진단 받은 환아들 중 천식 집중 교육 프로그램에 참가한 15가족을 교육 참가군으로 선정하였고, 교육 프로그램에 참가하지 않은 천식 환아 15가족을 대조군으로 하였다. 교육 참가군은 프로그램 시작 직전과 3개월 후, 대조군은 같은 기간에 3개월의 간격을 두고 각각 2회씩 설문조사를 시행하여 천식 환아와 보호자의 천식관리 이행 정도와 천식 인식도, 천식 환아의 자기 효능감 및 삶의 질의 변화를 측정하였다. 결 과 : 교육 참가군에서 교육 프로그램 참가 후 천식 환아의 자가관리 이행 정도(교육 전; 27.1점 vs. 교육 후; 32.2점, P=0.011), 천식 인식도(14.2점 vs. 17.9점, P<0.001), 자기 효능감 평가 항목(42.2점 vs. 45.0점, P=0.091) 중 문제 해결 능력(12.5점 vs. 14.2점, P=0.012), 삶의 질(79.6점 vs. 88.6점, P<0.001)에서 통계적으로 유의하게 점수가 높아졌으며 보호자의 천식관리 이행 정도(39.9점 vs. 42.1점, P=0.199)와 천식 인식도(15.8점 vs. 16.9점, P=0.178)는 약간 높아졌으나 통계적으로 유의한 변화를 보이지 않았다. 대조군에서는 천식 환아의 천식 인식도 중 천식의 급성 증상과 만성질환으로서의 천식에 대한 이해(4.1점 vs. 5.2점, P=0.025)와 삶의 질 중 정서적 활동(77.7점 vs. 84.3점, P=0.023)에 대한 영역에서 유의하게 점수가 증가하였으나 다른 항목에서는 유의한 차이가 없었으며 보호자의 천식관리 이행 정도와 천식 인식도에서는 변화가 없었다. 결 론 : 천식 집중 교육 프로그램을 통하여 천식 환아들의 삶의 질, 자가 관리 이행 정도, 자기 효능감, 천식 인식도 등을 향상 시킬 수 있었으며, 이러한 프로그램을 더욱 많이 개발하고 시행하여 천식 환아들의 천식 관리가 잘 이루어 질 수 있도록 해야 할 것이다.

Purpose : Asthma is one of the most common chronic childhood disease. Education of asthmatic children and their families about asthma and its management may improve disease control, reduce symptoms, and improve school performance. The aim of the study was to evaluate the effects of an intensive asthma education program in asthmatic children and their families on outcome measure of asthma management behavior scale, knowledge about asthma, self efficacy scale and quality of life. Methods : Fifteen asthmatic children and their families were invited the intensive asthma education program which including allergen avoidance, management of asthma, correct use of the inhalation devices and control of exercise-induced asthma (study group). Fifteen asthmatic children and their families those who did not participate this program were served as control group. Participants were asked to complete a written questionnaire before and 3-month after the program. Results : After completing the intensive education program, significant improvement of the childrens asthma management behavior scale (27.1 vs. 32.2, P=0.011), belief and knowledge about asthma (14.2 vs. 17.9, P<0.001), self efficacy (47.9 vs. 49.7, P=0.091) and quality of life (79.6 vs. 88.6, P<0.001) was noted in the study group by measuring questionnaires. There are increasing tendencies in parental asthma management behavior scale and knowledge about asthma. Conclusion : This intensive asthma education program is effective in improving asthma control, self efficacy and quality of life of asthmatic children. This should serve as a national model for family-based programs for asthmatic children and their families.

키워드

과제정보

연구 과제 주관 기관 : 한국 보건사회연구원

참고문헌

  1. Clark NM, Feldman CH, Evans D, Levison MJ, Wasilewski Y, Mellins RB. The impact of health education on frequency and cost of health care use by low income children with asthma. J Allergy Clin Immunol 1986;78:108-15 https://doi.org/10.1016/0091-6749(86)90122-3
  2. Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, et al. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995-2000. Clin Exp Allergy 2004;34:1556-62 https://doi.org/10.1111/j.1365-2222.2004.02084.x
  3. MacLean WE, Jr., Perrin JM, Gortmaker S, Pierre CB. Psychological adjustment of children with asthma: effects of illness severity and recent stressful life events. J Pediatr Psychol 1992;17:159-71 https://doi.org/10.1093/jpepsy/17.2.159
  4. McNelis AM, Huster GA, Michel M, Hollingsworth J, Eigen H, Austin JK. Factors associated with self-concept in children with asthma. J Child Adolesc Psychiatr Nurs 2000;13:55-68 https://doi.org/10.1111/j.1744-6171.2000.tb00079.x
  5. Schlosser M, Havermans G. A self-efficacy scale for children and adolescents with asthma: construction and validation. J Asthma 1992;29:99-108 https://doi.org/10.3109/02770909209059878
  6. Torres R, Fernandez F. Self-esteem and value of health as determinants of adolescent health behavior. J Adolesc Health 1995;16:60-3 https://doi.org/10.1016/1054-139X(94)00045-G
  7. Lenfant C, Hurd SS. National Asthma Education Program. Chest 1990;98:226-7 https://doi.org/10.1378/chest.98.1.226
  8. Evans D, Mellins RB. Educational programs for children with asthma. Pediatrician 1991;18:317-23
  9. Moe EL, Eisenberg JD, Vollmer WM, Wall MA, Stevens VJ, Hollis JF. Implementation of "Open Airways" as an educational intervention for children with asthma in an HMO. J Pediatr Health Care 1992;6:251-5 https://doi.org/10.1016/0891-5245(92)90023-W
  10. Kaplan DL, Rips JL, Clark NM, Evans D, Wasilewski Y, Feldman CH. Transferring a clinic-based health education program for children with asthma to a school setting. J Sch Health 1986;56:267-71 https://doi.org/10.1111/j.1746-1561.1986.tb05748.x
  11. Lim JY, Choung JT. A model of camp program for childhood asthma. Pediatr Allergy Respir Dis[Korea] 1998;8;155-66
  12. Lim JY, Chung SM, Choung JT. The role of patient and parents education in the management of pediatric asthma. Pediatr Allergy Respir Dis[Korea] 2000;10:51-60
  13. Yoon JK, Chung SM, Choung JT. A model of education program for childhood asthma. Pediatr Allergy Respir Dis [Korea] 1997;7:69-81
  14. Mesters I, Meertens R, Crebolder H, Parcel G. Development of a health education program for parents of preschool children with asthma. Health Educ Res 1993;8:53-68 https://doi.org/10.1093/her/8.1.53
  15. Kieckhefer GM. Testing self-perception of health theory to predict health promotion and illness management behavior in children with asthma. J Pediatr Nurs 1987;2:381-91
  16. Bartholomew K. The Asthma Knowledge Questionnaire (dissertation). Houston: Univ. of Texas Health Science Center at Houston, 1998
  17. Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care 1999;37:126-39 https://doi.org/10.1097/00005650-199902000-00003
  18. Feldman CH, Clark NM, Evans D. The role of health education in medical management of asthma. Some program applications. Clin Rev Allergy 1987;5:195-205
  19. Lewis CE, Lewis MA. Evaluation and implementation of self-management programs for children with asthma. J Allergy Clin Immunol 1987;80:498-500 https://doi.org/10.1016/0091-6749(87)90085-6
  20. Hindi-Alexander MC. Asthma education programs: their role in asthma morbidity and mortality. J Allergy Clin Immunol 1987;80:492-4 https://doi.org/10.1016/0091-6749(87)90083-2
  21. Evans D, Clark NM, Feldman CH, Rips J, Kaplan D, Levison MJ, et al. A school health education program for children with asthma aged 8-11 years. Health Educ Q 1987;14:267-79 https://doi.org/10.1177/109019818701400302
  22. McNabb WL, Wilson-Pessano SR, Hughes GW, Scamagas P. Self-management education of children with asthma: AIR WISE. Am J Public Health 1985;75:1219-20 https://doi.org/10.2105/AJPH.75.10.1219
  23. Lewis CE, Rachelefsky G, Lewis MA, de la Sota A, Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics 1984;74:478-86
  24. Yoon YM. Effects of an asthma camp program on self care behavior of asthmatic children(dissertation). Seoul: Korea Univ. 2001
  25. Clark NM, Evans D, Zimmerman BJ, Levison MJ, Mellins RB. Patient and family management of asthma: theory-based techniques for the clinician. J Asthma 1994;31:427-35 https://doi.org/10.3109/02770909409089484
  26. Legorreta AP, Leung KM, Berkbigler D, Evans R, Liu X. Outcomes of a population-based asthma management program: quality of life, absenteeism, and utilization. Ann Allergy Asthma Immunol 2000;85:28-34 https://doi.org/10.1016/S1081-1206(10)62430-1
  27. Creer TL, Backial M, Burns KL, Leung P, Marion RJ, Miklich DR, et al. Living with Asthma. I. Genesis and development of a self-management program for childhood asthma. J Asthma 1988;25:335-62 https://doi.org/10.3109/02770908809071375
  28. Tettersell MJ. Asthma patients' knowledge in relation to compliance with drug therapy. J Adv Nurs 1993;18:103-13 https://doi.org/10.1046/j.1365-2648.1993.18010103.x
  29. Anderson M. Effects of an inpatient asthma education program for children and adolescents on self-efficacy scores (dissertation). Alington : Univ. of Texas at Alington, 1997
  30. Moy ML, Israel E, Weiss ST, Juniper EF, Dube L, Drazen JM. Clinical predictors of health-related quality of life depend on asthma severity. Am J Respir Crit Care Med 2001;163:924-9 https://doi.org/10.1164/ajrccm.163.4.2008014
  31. Meltzer EO. Quality of life in adults and children with allergic rhinitis. J Allergy Clin Immunol 2001;108(1 Suppl):45S-53S https://doi.org/10.1067/mai.2001.115566
  32. Bender BG, Annett RD, Ikle D, DuHamel TR, Rand C, Strunk RC. Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. CAMP Research Group. Arch Pediatr Adolesc Med 2000;154:706-13 https://doi.org/10.1001/archpedi.154.7.706
  33. Okelo SO, Wu AW, Krishnan JA, Rand CS, Skinner EA, Diette GB. Emotional quality-of-life and outcomes in adolescents with asthma. J Pediatr 2004;145:523-9 https://doi.org/10.1016/j.jpeds.2004.06.043
  34. Gringeri A, von Mackensen S, Auerswald G, Bullinger M, Perez Garrido R, Kellermann E, et al. Health status and health-related quality of life of children with haemophilia from six West European countries. Haemophilia 2004;10 Suppl 1:26-33 https://doi.org/10.1111/j.1355-0691.2004.00876.x
  35. Simons FE. Learning impairment and allergic rhinitis. Allergy Asthma Proc 1996;17:185-9
  36. Varni JW, Burwinkle TM, Rapoff MA, Kamps JL, Olson N. The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module. J Behav Med 2004;27:297-318 https://doi.org/10.1023/B:JOBM.0000028500.53608.2c
  37. Dielman TE, Leech SL, Becker MH, Rosenstock IM, Horvath WJ, Radius SM. Dimensions of children's health beliefs. Health Educ Q 1980;7:219-38 https://doi.org/10.1177/109019818000700304
  38. Hendricson WD, Wood PR, Hidalgo HA, Ramirez AG, Kromer ME, Selva M, et al. Implementation of individualized patient education for Hispanic children with asthma. Patient Educ Couns 1996;29:155-65 https://doi.org/10.1016/0738-3991(96)00861-0
  39. Green LW, Levine DM, Deeds S. Clinical trials of health education for hypertensive outpatients: design and baseline data. Prev Med 1975;4:417-25 https://doi.org/10.1016/0091-7435(75)90030-4

피인용 문헌

  1. Impact of symptom management training among asthmatic children and adolescents on self-efficacy and disease course vol.52, pp.8, 2008, https://doi.org/10.3109/02770903.2015.1010732