We propose to (1) demonstrate the efficacy of health education to improve the management of asthma in low income, urban minority families with pre-school children who have asthma severe enough to require hospitalization; and (2) test the hypothesis that training parents to observe, record and evaluate their child's asthma symptoms can significantly enhance the effectiveness of family asthma management training. A total of 435 families with children less than seven years of age who have been admitted to Presbyterian Hospital with a diagnosis of asthma will be enrolled in three treatment groups: (1) control; (2) asthma management training; and (3) asthma management training plus symptom observation and evaluation training. All three groups will receive three sessions held over two months: only parents will receive training. The control group will receive a health education program unrelated to asthma. The asthma management training is based on cognitive social learning theory and will use modeling and enactive mastery to teach management skills and increase self-efficacy. The observation and evaluation intervention applies self-regulation theory to the family unit of parent and child. We hypothesize that a health education program that incorporates training in symptom observation and evaluation will (a) increase parental observation of child's symptoms, (b) improve their standards for evaluating the child's symptoms, (c) increase the frequency and diversity of asthma management strategies parents use and (d) increase their perception of control of the child's symptoms. These in turn will lead to (1) reduced days with symptoms of asthma; (2) decreased use of emergency health care services; and (3) decreased disruption of family life. Data will be collected while the child is hospitalized, after the intervention, and at one year and two years. Changes in parental behavior will be measured with our Asthma Self-Management Index and with new scales developed to measure parental self-regulation processes. In addition to obtaining objective records of hospitalization and emergency room (ER) visits, we will assess the frequency of days in which the child experiences symptoms, the quality of family life, and the transfer of observation and evaluation skills from parents to older children. The results should be applicable to the management of other chronic diseases in low income minority populations.
