Discussion: Weighing the Evidence
Summary of Research Article Selected
The article by Ahmad & Grimes is a systematic review of the published research examining the effects of asthma self-education for school-age children on number of school days missed, emergency department visits, and hospital visits (2011). The systematic review is at the pinnacle of the hierarchy of levels of evidence, giving the strongest evidence coming from careful synthesis of multiple studies (Polit & Beck, 2017).
The review contains a question that is clearly defined, uses a Health Promotion Model theoretical framework, well-defined inclusion criteria, and a wide sample size.
Data and Results
By analyzing the data and study design, the value and informativeness of this systemic review can be determined (Bernd, du Prel, & Blettner, 2009).
The systematic review included nine studies with one common purpose, which was to provide education to children with asthma in order to increase their knowledge of asthma and ultimately improve their self-care (Ahmad & Grimes, 2011). The majority of the studies were randomized controlled experiments, with target populations ranging from 18 to over 900 children showing a strong sample size (Ahmad & Grimes, 2011).
The reviewed studies analyzed differences in the students' preintervention and postintervention measurements, with the most common follow-up interval being 12 months (Ahmad & Grimes, 2011). The researchers concluded that school-based asthma education programs substantially improve school attendance for students with asthma, but it is unclear whether these programs can decrease the frequency of emergency department visits and hospitalizations (Ahmad & Grimes, 2011).
Weaknesses of Analysis and Alternate Interpretation of Data
The review states that the biggest weakness of the studies is that asthma severity was not accounted for, which dictates a child's treatment course and frequency of attacks (Ahmad & Grimes, 2011).
This makes it difficult to compare a child who only occasionally needs a rescue inhaler with physical exertion to a child who takes several maintenance medications with a more frequent occurrence of attacks. An alternate interpretation of the data could be that the asthma education provided is reduced emergency department visits, but perhaps the children were taken to their primary care provider or an urgent care, rather than the ED.
This would demonstrate a decrease in the number of ED visits recorded, while the children are still being seen for asthma in a different care setting. Additional research into the frequency at which children take asthma medications and medication compliance could provide further insight into the impact asthma severity has on missed school days and ED visits.
References
Ahmad, E. & Grimes, D. (2011). The effects of self-management education for school-age children on asthma morbidity: A systematic review. The Journal of the School Nursing, 27(4), 282-292.
Bernd, R., du Prel, J.B., & Blettner, M. (2009). Study design in medical research: Part 2 of a series on the evaluation of scientific publications. Deutsches Aerzteblatt International, 106(11), 184-189. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695375/pdf/Dtsch_Arztebl_Int-106-0184.pdf
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.