Improved health outcomes for adolescents with asthma in Jordan: A cluster randomized controlled trial

OBJECTIVE. The objective of this study was to determine the effect of a peer-led asthma education program on health-related outcomes in students with asthma attending high schools in Jordan.

METHODS. In this cluster-randomized controlled trial, 4 high schools in Irbid, Jordan, were randomly assigned to receive the Adolescent Asthma Action (Triple A) program or standard practice. Trained bilingual health workers facilitated the Triple A, which uses a three-step cascade process to train peers from years 10 and 11 over a three week period. This peer training aims at delivering asthma education for the school community, with the aid of well-established resources including peer training manuals, videos and props. Students with asthma (n = 261) in years 8, 9 and 10 were surveyed at baseline in December 2006 and three months post-intervention. The main outcomes were asthma-related quality of life, knowledge of asthma management, and self-efficacy to resist smoking.

RESULTS.  Statistically and clinically significant improvements at three months in the intervention group in comparison to the control group for quality of life (mean difference = 1.35, 95% CI 1.04 – 1.76), asthma-related knowledge (mean difference = 1.62, 95% CI 1.15 – 2.19), and self-efficacy to resist smoking (mean difference = 4.63, 95% CI 2.93 – 6.35).

CONCLUSIONS. This randomized controlled trial demonstrated the success of a school-based, peer-led education program in improving important outcomes for adolescents with asthma. Furthermore, it is clear that Triple A can be readily adapted to suit different cultures and contexts. Adolescents can teach their peers about managing asthma and avoiding smoking and also be capable allies and responsible partners in health promotion programs when they are given an opportunity. Finally, school-based peer-led health education programs have strong potential to be used for other adolescent health issues such as smoking and obesity prevention.