Developing an Asthma Tool for Schools: The Formative Evaluation of the Michigan Asthma School Packet

Article excerpt


* To examine the influence of formative evaluation and persuasion theory on the development of the Michigan Asthma School Packet (MASP)

* To identify the innovative characteristics of the MASP and their basis in formative findings and theoretical grounding

* To share lessons learned from this formative effort to enhance other intervention planning or design


Michigan has 4475 public schools serving grades K-12. These schools employ 80,991 teachers, 4673 administrators, and 13,309 administrative support staff. A recent Michigan Department of Education survey of the state's school health services found that less than 16% of all schools housed a full-time school health professional and less than 23% of all schools housed either a half- or full-time school health professional. Of the schools selected to receive the MASE 80% are located in counties considered to be part of a Metropolitan Statistical Area.


Michigan has a strong collaboration of public and private organizations called the Asthma Initiative of Michigan (AIM). In February 2000, as part of this initiative, the Michigan Department of Community Health convened 125 asthma experts with knowledge in the areas of clinical care, education, environmental quality, and surveillance from across the state to address asthma prevention and control. Development of the MASP is one of many AIM activities focused on asthma management in school.


The theoretical basis of the MASP is the Extended Parallel Process Model (EPPM). The EPPM predicts behavior by addressing the underlying motivational mechanisms that prompt health-related behavior change in a variety of contexts? The EPPM states that the target of a health message makes an assessment of threat and efficacy. Threat is a function of "susceptibility," or perceived likelihood that one will be affected, and "severity," or perceived seriousness once affected; efficacy is a function of "response efficacy," or perceived likelihood that the recommended response will avert the threat, and "self-efficacy," or perceived capability that one will be able to carry out the recommended response. Targets perceiving low threat will not attend to the message and make no assessment of efficacy. Targets perceiving high threat but low efficacy will attend to the message but fail to engage in behavior change because they feel incapable or they do not think the recommended response will alleviate the threat. Attention to the message and behavior change are predicted only when targets perceive both high threat and high efficacy. This theory informed the entire intervention including its form, message strategy, design, and scope. Focus on this theory of persuasion seemed warranted because educational print interventions commonly fail to show effects at least in part because their intended targets do not attend to them. (2) In addition, research shows that extensive, theory-driven formative evaluation can lead to more effective interventions. (3)

The formative evaluation plan aimed to determine school employees' perceptions of students' asthma as well as school employees' perceptions of asthma needs and recommended solutions. This plan included a national review of asthma school materials targeting school employees, a survey and interview of school workers, and a survey of youth with asthma and their parents. A team of Michigan asthma experts that included school nurses, pulmonary pediatricians, state health representatives, community asthma program directors, asthma coalition members, and asthma researchers advised the development process with leadership from 2 external communication researchers.

The team reviewed several packets from various states and agencies for content, format, and design. Team members sought to identify effective characteristics of the packets to avoid wasting time and resources by duplicating previously successful tools. …