Children's Asthma Research Institute and Hospital (CARIH) in Denver have been credited with establishing the background for asthma patient education and self-management (Decker and Kaliner, 1988). Those publications show the emerging awareness that patients and their families first had to learn about asthma management skills and competencies; patients then had to demonstrate that they could perform these skills to help control the disorder. This approach reflects the learning-performance distinction inherent in social learning theory (Bandura, 1986). Effectively performing management skills achieved the aim of permitting patients to become partners with their physicians in controlling their asthma.
By the mid-1970s, it was apparent to many health professionals in the United States that greater emphasis had to be placed on developing and evaluating self-management programs for asthma. By the end of the decade, more than two dozen such "first generation" programs for childhood asthma had been developed and evaluated. A similar number, many of which were still undergoing testing, had been created for adults. Recently, Creer and coworkers (1990) and Wigal and colleagues (1990) reviewed 19 education and self-management programs for childhood asthma (Table 8-1).
A number of positive results were obtained from the earliest of these programs. Significant findings included decreases in the number of attacks, in hospital use (including visits to hospital emergency rooms), in school absenteeism, and in asthma-related costs. Investigators also found increases in peak flow rates; improved attitudes toward asthma, including the perceived ability of patients that they could help control it; and improved self-esteem. The investigators who conducted these studies included both medical and behavioral scientists who had worked together for a number of years on the problems of asthma. Other positive findings suggested by Wigal and colleagues (1990) included the following:
In most instances, children and their parents became partners with their physicians in the management of the children's asthma.
The programs were applied in a broad array of settings, including those serving children from different socioeconomic backgrounds.
There was evidence that some dependent measures were valid and reliable, although flaws were found in many questionnaires.
Perhaps the greatest contribution of the programs was the development and availability of a variety of educational materials and techniques that could be used to teach self-management to patients and their families. Indeed, a veritable smorgasbord of programs is available to teach asthma management skills to patients (Creer et al., 1992).
The overall impact of these programs was positive, and virtually all of them were able to demonstrate the acquisition of knowledge about asthma and self-management skills. Yet most of these early programs did not assess