Asthma Management Practices In Two Ontario School Districts: Applying Knowledge to Action

Abstract

Background: School settings are one of the most crucial context for asthma management second only to a child’s home. Today school administrators are faced with many challenges, not only are they responsible for students' learning needs but they also manage complex behavioural and health issues including asthma. Most do not have standardized plans regarding asthma management. Objectives: 1) Systematically review the research literature related to asthma management within the school setting. 2) Determine current asthma management practices as reported by school administrators. 3) Explore experiences and barriers to asthma management practices with school administrators. Method: Guided by the Knowledge to Action framework, the study was divided in three phases using a planned action approach and included an integrative synthesis of the evidence, an administrators’ survey, and an administrator’s meeting. Findings: Phase One: Following a search using three databases, 67 articles were critiqued. The literature illustrates that many countries have established “asthma friendly schools” legislation that includes process for identifying children with asthma, right to self-carry and administer medications, enhancing communication and cooperation between school staff, parents, and children with asthma, reducing triggers in school environment, and effective policies that make legislation a functioning reality within schools. Phase Two: Ninety-seven surveys were distributed within two district school boards with 61 completed surveys returned (63% response rate). Key findings included underestimation of the prevalence of asthma, no standardized process for identifying children with asthma, staff training deficiency for recognizing and responding to asthma exacerbations, lack of individual asthma action plans for children, absence of programs to support current legislation and best practice guidelines. Communication was the most common barrier identified by school administrators. Phase Three: Two principals in an administrator’s meeting validated the survey results. Participants were not familiar with the concept of asthma friendly school, asthma prevalence rates, or free school asthma resources. Asthma Action Plans were not universally understood as individualized written plans but rather a generalized first aide response plan. Conclusion: There are knowledge and practices gaps placing children with asthma at risk for exacerbation and death within school setting. Administrators want to partner to facilitate optimal asthma management within the school setting.