Indigenous healthcare worker involvement for Indigenous adults and children with asthma
Abstract
Background
Asthma education is regarded as an important step in the management of asthma in national guidelines. Racial 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 programmes, improves asthma related outcomes in indigenous children and adults with asthma.
Search methods
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 December 2008.
Selection criteria
All randomised controlled trials comparing involvement of an indigenous healthcare worker (IHW) in comparison to absence of an IHW in asthma education programmes 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
Only a single study was applicable for this review, and included 24 children randomised to an asthma education programme involving an IHW, compared to a similar intervention without an IHW. Twenty two of these children completed the trial. Only one outcome (asthma knowledge in children, mean difference of 3.30 units, 95% CI 1.07 to 5.53) significantly favoured the IHW involvement group. However, although not statistically significant, all the outcomes favoured the group that had IHW involvement in the asthma education program. There were no studies in adults.
Authors' conclusions
The involvement of IHW in asthma programs targeted for their own ethnic group in one small trial was beneficial for some but not all asthma outcomes. Thus there is insufficient data to be confident that the involvement of IHW is beneficial 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.
PICOs
Plain language summary
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 programmes improves asthma related outcomes in Indigenous children and adults with asthma. There was only one relevant study with 24 children eligible for inclusion, and the involvement of an IHW, specifically targeting clients of the same ethnic group, was beneficial in one, but not all, asthma‐related outcomes. There is insufficient data to be absolutely confident that the involvement of IHW is beneficial in all like 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 unless new research data show otherwise. More studies are clearly required to address this question so to inform relevant clinical practice and health policy.
