Asthma Management Practices and Education Needs of Head Start Directors and Staff. (Articles)

Article excerpt

Head Start programs emphasize the importance of early identification of health problems and implementation of comprehensive health programs for preschool children. One health problem frequently identified in Head Start programs is asthma. (1,2) Previous studies of asthma among three- to five-year-old Head Start children indicated a prevalence rate of 13.4% in 1992 and 22.7% in 1993. (3) A study of 2,215 Wisconsin Head Start children reported a 15.8% prevalence rate for physician-diagnosed asthma. (4) A study of families at 18 Head Start programs in Chicago indicated a prevalence rate of 13.9% for diagnosed asthma in children. (5) A survey of inner city Head Start programs in Baltimore, Md., documented asthma as the number one health problem. (6) Morbidity associated with asthma in Head Start children is also noteworthy. In the Wisconsin study, more than one-half the children with asthma used the emergency department at least once during their lifetime for asthma treatment, and more than one-fourth had been hospitalized for asthma. (4)

One significant barrier to achieving adequate asthma control in preschool-aged children may be poor asthma management practices resulting from lack of regular asthma care, inconsistent, or nonexistent patient education about asthma and asthma medication use, lack of culturally sensitive asthma education materials, and inadequate social support. (7,8) Parents of young children with a recent diagnosis of asthma are often less knowledgeable and skilled in asthma management, including symptom perception or identification, than parents of older children. (9) Inaccurate symptom recognition, or the inability to identify symptoms early, is associated with poor asthma management resulting in increased morbidity and mortality. (9)

Because asthma is such an important health problem among Head Start children, it is important to obtain information about the management practices and education of personnel who work in Head Start programs. In particular, it is important to know about the asthma education received by Head Start personnel who interact with children with asthma and their families. Lack of adequate knowledge could increase morbidity in the school setting. A child may have increased morbidity on school time as a result of inadequate personnel, or parents who do not get the guidance they need when the child is still young, making it hard for the parent to help the child.

Head Start directors and staff typically work together with families to manage chronic health problems, but asthma education programs usually target health professionals, not Head Start directors and staff. In addition, limited information exists about asthma management practices and education needs of Head Start directors and staff. This paper describes the asthma management practices and education needs of Head Start directors and staff in 15 Baltimore, Md., Head Start programs.


From February to December 2000, all Head Start staff and directors participating in an asthma education intervention at 15 Head Start programs were asked to complete a written survey and return the survey to investigators in a self-addressed, stamped envelope. Surveys were hand delivered to the Head Start director who then distributed them to staff. After five weeks, a second copy of the survey was mailed to staff who did not complete the first survey. On completion and return of the survey, each staff member received $10 for completing the survey.

The survey distributed to directors contained 50 items that assessed staff asthma care practices, beliefs, education activities, and sociodemographic information. The survey distributed to the Head Start staff contained 52 items. Both surveys took approximately 30 minutes to complete. The Johns Hopkins University School of Medicine's Institutional Review Board, the Joint Commission on Clinical Investigation, approved the study. …