Indigenous healthcare worker involvement for indigenous adults and children with asthma

World-wide indigenous people with asthma are disproportionately represented in the severe end of the disease spectrum. Appropriate models of care are important in the successful delivery of services, and are likely contributors to improved outcomes for people with asthma. In this review, we examined if involvement of an indigenous healthcare worker (IHW) (when compared to absence of an IHW) in asthma education programs improves asthma related outcomes in Indigenous children and adults with asthma. There was only one study involving 113 people eligible for inclusion in this review. The participants showed improvement in the patient's asthma knowledge score, the parent's asthma skill score and a reduction in the number of days missed from school in children who were cared for by an indigenous healthcare worker. However as exacerbation frequency was not reduced and there was only a single, small study, we cannot be confident of the results although we think it is likely that the involvement of IHW is beneficial. Nevertheless, given the complexity of health outcomes and culture as well as the importance of self-determination for indigenous peoples, the practice of including IHW in asthma education programs for indigenous children and adults with asthma is justified, but should be subject to further randomised controlled trials

Authors' conclusions: 

The involvement of IHW in asthma programs targeted for their own ethnic group in one small trial was beneficial in improving most, but not all asthma outcomes in children with asthma. It is very likely that involvement of an IHW is beneficial. However as exacerbation frequency was not significantly different between groups, we cannot be confident of the results in all settings. Nevertheless, given the complexity of health outcomes and culture as well as the importance of self-determination for indigenous peoples, the practice of including IHW in asthma education programs for indigenous children and adults with asthma is justified, but should be subject to further randomised controlled trials.

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Background: 

Asthma education is regarded as an important step in the management of asthma in national guidelines. Racial, ethnicity and socio-economic factors are associated with markers of asthma severity, including recurrent acute presentations to emergency health facilities. Worldwide, indigenous groups are disproportionately represented in the severe end of the asthma spectrum. Appropriate models of care are important in the successful delivery of services, and are likely contributors to improved outcomes for people with asthma.

Objectives: 

To determine whether involvement of an Indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programs, improves asthma related outcomes in indigenous children and adults with asthma.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles. The latest search was in January 2011.

Selection criteria: 

All randomised controlled trials comparing involvement of an Indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programs for indigenous people with asthma.

Data collection and analysis: 

Two independent review authors selected data for inclusion, a single author extracted the data. Both review authors independently assessed study quality. We contacted authors for further information. As it was not possible to analyse data as "intention-to-treat", we analysed data as "treatment received".

Main results: 

One study fulfilled inclusion criteria involving 113 children randomised to an asthma education programme involving an IHW, compared to a similar education programme without an IHW. Eighty eight of these children completed the trial. Parents' asthma knowledge score (mean difference (MD) (7.49; 95% CI 5.52 to 9.46), parents' asthma skill score (MD 0.98; 95% CI 0.52 to 1.44) and days absent from school (100% school-aged children in the intervention group missed <7 days, 21% of controls missed 7-14 days, difference = 21%, 95% CI 5-36%) were significantly better in the intervention group compared to controls. There was no significant difference in mean number of exacerbations (per year) between groups. There was no difference in quality of life or children's asthma skill score; both were limited to one study only and the direction favoured IHW group. There were no studies in adults.

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