Methods

Randomised single blind, parallel comparison of 2 types of interventions: Multifamily asthma group treatment (MFAGT = IHW involvement) vs Standard Psycho‐educational Asthma Intervention (SPAI = no IHW involvement) in children with asthma. These two interventions were also compared to controls (no additional education) that were randomly selected from pool of patients with asthma.

Potential participants invited to participate in MFAT or SPAI. Patients completed 2 assessments (see outcome measures); one at enrolment and the 2nd was one year following intervention.

Randomisation and allocation method not described.

All completed trial but 2 did not complete 2nd evaluation. These 2 families were omitted from analysis in the published paper.

Quality score: Allocation concealment‐B; Blinding‐C; Reporting of participants by allocated group‐A; Follow up‐B.

Participants

24 families randomised from 47 families screened; 22 completed the study. 16 (73%) were Hispanic and 6 (27%) were African‐American. Families with children with asthma were enrolled from Martha Eliot Health Centre, an inner‐city community health centre which is part of the Boston's Children Hospital. Mean age of children randomised was 10.2, 13 (59%) were boys and 9 (41%) girls. The control group had 11 families and were matched to the intervention group by ethnicity, age and sex. All children were from low socio‐economic background.

Inclusion: African‐American or Hispanic descent, aged 7‐13 years with asthma diagnosed by primary care physician.

Exclusion: None described.

Interventions

MFAT is based on allocentric self‐orientation and socio‐economic context of ethnic minorities. Program delivery included a Hispanic and African‐American educator/psychologist. MFAT also emphasised relational and collaborative asthma management among children, family, their primary physician, and mental health specialist (as opposed to learning in isolation from others). The program framed asthma symptoms and problems within a historical and socioeconomic context. It also uses a manual that has 3 modules, each taught in an hour on different days:
1. Identifying and monitoring asthma symptoms and learning to effectively use medical/contextual resources (peak flow, medications) to control symptoms
2. Identifying and preventing asthma triggers
3.Preventing and coping with an asthma attack (eg asthma plans)

SPAI: has the same 3 modules above but followed a structured teaching approach without seeing asthma symptoms within the socioeconomic or cultural context. Thus this asthma education/management strategies did not include contingency plans that emphasised cultural resources.

For the analysis MFAT group is surmised as IHW involved and SPAI as no IHW involved

Outcomes

1. Number of asthma related ED visits
2. Individualism‐Collectivism scale
3. Asthma Behavioural Assessment which consists of Asthma Knowledge (AK) and Asthma Skills (AS), both in parents and children. AK scores range from 0 to 12 and AS range from 17 to 85.

Notes

Comments
Paper provided data that compared MFAT to SPAI and to controls. However, as the control group was not randomised, control group data was not included in analysis.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

Third party allocation