Asthma Medication Use and General Asthma Management in Saudi Arabian Primary Schools

Asthma is one of the most common chronic diseases among children. Asthma affects children’s quality of life, sleep, social and physical activities, and academic performance at school. This effect on children’s quality of life places a burden on their caregivers (parents) and the family milieu. These facts suggest that schools are and should be an important setting for asthma care. While children attend school, the caregiving role is partly transferred from parents to teachers, and peers can also play a pivotal role by creating a supportive environment, despite not being involved in care provision. Given the significant effects of asthma, it is important that all teachers have working knowledge of asthma in order to be able to understand asthma symptoms, help children with asthma use their medications when needed, and assist in emergency situations, as, in most cases, teaching occurs with a single teacher educating a given class. Unfortunately, a review of the literature revealed that teachers’ asthma knowledge and symptom management skills are suboptimal. With such research findings emanating from various countries, many programs have been developed in Australia, Europe, and the United States to improve awareness about childhood asthma and to provide trainees (teachers) with the skills necessary to recognise and provide appropriate first aid to children experiencing a worsening of symptoms in the school setting. Many other programs were also conducted in the school setting, which focused on children with asthma, school resources (such as nurses/medical staff), and the entire school community. The majority of research in this field and program development is reported from developed, English-speaking countries with a traditionally high prevalence of asthma and allergies in children. However, current epidemiological data indicate that the burden of asthma is shifting globally, with many developed countries demonstrating static trends in prevalence and developing countries exhibiting an increase in the prevalence of asthma, particularly among children. These data may or may not reflect a “true” increase, but they do reflect an increasing understanding asthma and recognition, and parallel changes in public health focus from communicable to non-communicable diseases in these countries. For example, in Saudi Arabia, there seems to be an increase in asthma prevalence in recent years, even though it has not been a country with a historically high prevalence of asthma. Given that asthma is only recently assuming importance because of its increasing prevalence, programs and investment in public awareness and education are likely to be lower in Saudi Arabia. Indeed, research suggests that Saudi Arabia’s school health infrastructure is not well developed and that there are no national-level policies on managing asthma in Saudi schools. Furthermore, research in this area is quite limited. To the best of my knowledge, the only published study on the topic suggested that most Saudi school staff have low levels of general asthma awareness and that misconceptions regarding asthma medications are common among Saudi school teachers. This situational context formed the basis for this research. Aim The overarching aim of this thesis was to develop, implement and evaluate an asthma education program for primary school teachers in Saudi Arabia. This aim will be achieved via successive phases, which included initially assessing the needs and preferences for educational programs (from both the school teachers and parents of school children with asthma) and culminated in implementing a pilot program that was constructed based on the identified needs. Methods This thesis used a comprehensive literature review as a building block for the research. This review explored the literature on asthma interventions provided in primary schools and targeted school teachers, personnel, nurses with or without children, children’s peers, and children’s parents. Medline, PubMed, ERIC, CINAHIL, IPA, Embase, and Informit were searched to identify studies on school-based asthma interventions published during the previous five years (2007 to 2012), in order to identify the gaps in this research area. The review was followed by the use of quantitative and qualitative methods to investigate the needs and preferences for school-based asthma support. The quantitative method used to assess the needs and preferences of school teachers was a cross-sectional questionnaire. This questionnaire included items related to asthma awareness (knowledge), attitudes towards roles in asthma, and the efficiency of school-based asthma policies. Data from this survey were tested for the reliability of responses and descriptively analysed. The survey was prepared in Arabic and administered to a random sample of primary school teachers working in Riyadh, Saudi Arabia. Qualitative methods (in-depth semi-structured interviews) were used to assess the needs and preferences of Saudi Arabian parents of children with asthma. School notice boards were used to inform Saudi parents about the study and request their participation; subsequently, interviews were conducted with the parents recruited via convenience sampling and passive snowballing approaches. The interviews were recorded, transcribed verbatim, and thematically analysed using a grounded theory approach. Based on the findings from these two projects, this research further undertook a project to develop, implement, and evaluate a school-based asthma education program for primary school teachers in Saudi Arabia. This phase of the research involved a pre- and post-test design with a random sample of teachers recruited from five Saudi primary schools for girls in Riyadh. The educational program was based on the principles of adult learning and supported by well-designed learning objectives; teaching formats matching these objectives; and a mixed-delivery method of hands-on demonstration, didactic lectures, role plays, and games. The knowledge/attitude survey developed above was used as one outcome, while another outcome was the demonstrated competence in asthma first aid provision using a simulated scenario. The data collected were tested for normality and pre- and post-comparisons of knowledge and attitudes. Asthma first aid competence tests were conducted using either parametric analyses methods (such as student’s t-tests) or their non-parametric equivalents (Mann-Whitney U or Wilcoxon signed rank tests). For all statistical analyses, the significance level was set at 0.05. Results The scoping review was first conducted with the aim of identifying evidence for school-based programs (n = 23 articles included). This review indicated that school-based asthma interventions vary in terms of: • Type—educational, non-educational, and mixed • Format—didactic lessons/educational sessions, workshops, structured education activities, extracurricular health activities, interactive digital story and story writing, educational pamphlets, and booklets • The targeted population—children with asthma with/without their peers, parents, school personnel, and school nurses • The method of delivering the intervention—health professionals, peers, school teachers, university students, booklets, pamphlets, and interactive media • The outcomes measured—clinical, humanistic, academic, economic, and system related • The methods/instruments used to measure these outcomes However, in general, these interventions all had positive outcomes, despite their variations. The cross-sectional questionnaire that targeted primary school teachers in Saudi Arabia (n = 1,139 teachers and 82 school managers) highlighted the need for an educational program. The awareness section demonstrated the reliability of the responses (Cronbach’s α = 0.82). Thus, the survey exercise clearly highlighted that Saudi primary school teachers have suboptimal levels of asthma awareness (the sample participants had a score of 9.69 from a range of 0 to 20) and low confidence in managing asthma in children. When asked about school policies, the sample participants alluded to the insignificant policy structure at their school. However, the survey highlighted mostly positive attitudes among participants towards their roles in asthma care and elicited the needs and preferences for school-based educational programs. Importantly, the majority of participants suggested that school-based asthma education would be a worthwhile concept and that they would be willing to participate. The findings of the semi-structured interviews with the parents of children with asthma (n = 20) supported the results of the survey. The parents perceived a lack of asthma-related policy, procedures, care, and support in Saudi primary schools. Their preferences for schoolbased asthma support were directed towards educating teachers and parents about asthma and first aid provision for asthma attacks. Many parents expressed their concerns about the physical and social environment of the school, stating that they preferred to keep their children at home when asthma flare-ups were occurring or were likely. The pilot testing of the asthma educational program (the School Asthma Action Program) with a sample of primary schools in Riyadh (n = 47) indicated improvement in teachers’ awareness of the disease and its management, from a median value of 11 (range: 5–18) pre-program to 15 (range: 7–18) post-program (p < 0.001). The results also demonstrated a small but significant improvement in teachers’ attitudes towards asthma management at schools, from a median value of 74 (range: 15–75) pre-program to 75 (range: 15–75) post-program (p = 0.043). In addition, the pilot testing improved the teachers’ competence and confidence in providing asthma first aid to children at school in case of an emergency. Conclusion The work conducted in this thesis provides vital information to guide the future design of school-based asthma interventions that are sustainable and economically viable. The findings may help health educators and school policy advisors to develop school-based asthma interventions that both school teachers and parents need and are willing to participate in. In general, this research demonstrates the positive effects of a school-based asthma education program on improving primary school teachers’ knowledge, skills, and confidence in assisting children with asthma. The findings also emphasise the need for development and implementation of asthma-related policies and procedures in Saudi Arabian primary schools

Asthma Medication Use and General Asthma Management in Saudi Arabian Primary Schools

Asthma is one of the most common chronic diseases among children. Asthma affects children’s quality of life, sleep, social and physical activities, and academic performance at school. This effect on children’s quality of life places a burden on their caregivers (parents) and the family milieu. These facts suggest that schools are and should be an important setting for asthma care. While children attend school, the caregiving role is partly transferred from parents to teachers, and peers can also play a pivotal role by creating a supportive environment, despite not being involved in care provision. Given the significant effects of asthma, it is important that all teachers have working knowledge of asthma in order to be able to understand asthma symptoms, help children with asthma use their medications when needed, and assist in emergency situations, as, in most cases, teaching occurs with a single teacher educating a given class. Unfortunately, a review of the literature revealed that teachers’ asthma knowledge and symptom management skills are suboptimal. With such research findings emanating from various countries, many programs have been developed in Australia, Europe, and the United States to improve awareness about childhood asthma and to provide trainees (teachers) with the skills necessary to recognise and provide appropriate first aid to children experiencing a worsening of symptoms in the school setting. Many other programs were also conducted in the school setting, which focused on children with asthma, school resources (such as nurses/medical staff), and the entire school community. The majority of research in this field and program development is reported from developed, English-speaking countries with a traditionally high prevalence of asthma and allergies in children. However, current epidemiological data indicate that the burden of asthma is shifting globally, with many developed countries demonstrating static trends in prevalence and developing countries exhibiting an increase in the prevalence of asthma, particularly among children. These data may or may not reflect a “true” increase, but they do reflect an increasing understanding asthma and recognition, and parallel changes in public health focus from communicable to non-communicable diseases in these countries. For example, in Saudi Arabia, there seems to be an increase in asthma prevalence in recent years, even though it has not been a country with a historically high prevalence of asthma. Given that asthma is only recently assuming importance because of its increasing prevalence, programs and investment in public awareness and education are likely to be lower in Saudi Arabia. Indeed, research suggests that Saudi Arabia’s school health infrastructure is not well developed and that there are no national-level policies on managing asthma in Saudi schools. Furthermore, research in this area is quite limited. To the best of my knowledge, the only published study on the topic suggested that most Saudi school staff have low levels of general asthma awareness and that misconceptions regarding asthma medications are common among Saudi school teachers. This situational context formed the basis for this research. Aim The overarching aim of this thesis was to develop, implement and evaluate an asthma education program for primary school teachers in Saudi Arabia. This aim will be achieved via successive phases, which included initially assessing the needs and preferences for educational programs (from both the school teachers and parents of school children with asthma) and culminated in implementing a pilot program that was constructed based on the identified needs. Methods This thesis used a comprehensive literature review as a building block for the research. This review explored the literature on asthma interventions provided in primary schools and targeted school teachers, personnel, nurses with or without children, children’s peers, and children’s parents. Medline, PubMed, ERIC, CINAHIL, IPA, Embase, and Informit were searched to identify studies on school-based asthma interventions published during the previous five years (2007 to 2012), in order to identify the gaps in this research area. The review was followed by the use of quantitative and qualitative methods to investigate the needs and preferences for school-based asthma support. The quantitative method used to assess the needs and preferences of school teachers was a cross-sectional questionnaire. This questionnaire included items related to asthma awareness (knowledge), attitudes towards roles in asthma, and the efficiency of school-based asthma policies. Data from this survey were tested for the reliability of responses and descriptively analysed. The survey was prepared in Arabic and administered to a random sample of primary school teachers working in Riyadh, Saudi Arabia. Qualitative methods (in-depth semi-structured interviews) were used to assess the needs and preferences of Saudi Arabian parents of children with asthma. School notice boards were used to inform Saudi parents about the study and request their participation; subsequently, interviews were conducted with the parents recruited via convenience sampling and passive snowballing approaches. The interviews were recorded, transcribed verbatim, and thematically analysed using a grounded theory approach. Based on the findings from these two projects, this research further undertook a project to develop, implement, and evaluate a school-based asthma education program for primary school teachers in Saudi Arabia. This phase of the research involved a pre- and post-test design with a random sample of teachers recruited from five Saudi primary schools for girls in Riyadh. The educational program was based on the principles of adult learning and supported by well-designed learning objectives; teaching formats matching these objectives; and a mixed-delivery method of hands-on demonstration, didactic lectures, role plays, and games. The knowledge/attitude survey developed above was used as one outcome, while another outcome was the demonstrated competence in asthma first aid provision using a simulated scenario. The data collected were tested for normality and pre- and post-comparisons of knowledge and attitudes. Asthma first aid competence tests were conducted using either parametric analyses methods (such as student’s t-tests) or their non-parametric equivalents (Mann-Whitney U or Wilcoxon signed rank tests). For all statistical analyses, the significance level was set at 0.05. Results The scoping review was first conducted with the aim of identifying evidence for school-based programs (n = 23 articles included). This review indicated that school-based asthma interventions vary in terms of: • Type—educational, non-educational, and mixed • Format—didactic lessons/educational sessions, workshops, structured education activities, extracurricular health activities, interactive digital story and story writing, educational pamphlets, and booklets • The targeted population—children with asthma with/without their peers, parents, school personnel, and school nurses • The method of delivering the intervention—health professionals, peers, school teachers, university students, booklets, pamphlets, and interactive media • The outcomes measured—clinical, humanistic, academic, economic, and system related • The methods/instruments used to measure these outcomes However, in general, these interventions all had positive outcomes, despite their variations. The cross-sectional questionnaire that targeted primary school teachers in Saudi Arabia (n = 1,139 teachers and 82 school managers) highlighted the need for an educational program. The awareness section demonstrated the reliability of the responses (Cronbach’s α = 0.82). Thus, the survey exercise clearly highlighted that Saudi primary school teachers have suboptimal levels of asthma awareness (the sample participants had a score of 9.69 from a range of 0 to 20) and low confidence in managing asthma in children. When asked about school policies, the sample participants alluded to the insignificant policy structure at their school. However, the survey highlighted mostly positive attitudes among participants towards their roles in asthma care and elicited the needs and preferences for school-based educational programs. Importantly, the majority of participants suggested that school-based asthma education would be a worthwhile concept and that they would be willing to participate. The findings of the semi-structured interviews with the parents of children with asthma (n = 20) supported the results of the survey. The parents perceived a lack of asthma-related policy, procedures, care, and support in Saudi primary schools. Their preferences for schoolbased asthma support were directed towards educating teachers and parents about asthma and first aid provision for asthma attacks. Many parents expressed their concerns about the physical and social environment of the school, stating that they preferred to keep their children at home when asthma flare-ups were occurring or were likely. The pilot testing of the asthma educational program (the School Asthma Action Program) with a sample of primary schools in Riyadh (n = 47) indicated improvement in teachers’ awareness of the disease and its management, from a median value of 11 (range: 5–18) pre-program to 15 (range: 7–18) post-program (p < 0.001). The results also demonstrated a small but significant improvement in teachers’ attitudes towards asthma management at schools, from a median value of 74 (range: 15–75) pre-program to 75 (range: 15–75) post-program (p = 0.043). In addition, the pilot testing improved the teachers’ competence and confidence in providing asthma first aid to children at school in case of an emergency. Conclusion The work conducted in this thesis provides vital information to guide the future design of school-based asthma interventions that are sustainable and economically viable. The findings may help health educators and school policy advisors to develop school-based asthma interventions that both school teachers and parents need and are willing to participate in. In general, this research demonstrates the positive effects of a school-based asthma education program on improving primary school teachers’ knowledge, skills, and confidence in assisting children with asthma. The findings also emphasise the need for development and implementation of asthma-related policies and procedures in Saudi Arabian primary schools

Healthcare students' knowledge, attitude and perception of pharmacovigilance: A systematic review.

OBJECTIVE:The objective of this review is to evaluate the existing evidence about the knowledge, attitude, and perceptions (KAP) of healthcare students towards pharmacovigilance and adverse drug reactions reporting (ADRs). METHODS:A systematic literature search was conducted using MEDLINE, CINAHL, EMBASE, ERIC, and Cochrane Database of Systematic Reviews via OVID. This review restricted the search to studies published in English from inception until December 2019. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was healthcare students' knowledge, attitude, and perceptions of pharmacovigilance. RESULTS:Of the 664 articles identified, twenty-nine studies were included in the review. Overall, healthcare students vary in their knowledge and attitude towards pharmacovigilance and ADRs reporting. There was inconsistency in measuring KAP between the studies and the main drawback in the literature is lacking validated KAP measures. CONCLUSIONS:In summation, optimal KAP assessment can be achieved through developing a standard validated measure. Our future healthcare providers should have basics pharmacovigilance knowledge in order to rationally reporting ADRs and preventing serious health problems

Qualitative insights into the need for a contraception protocol from obstetricians’ and gynecologists’ perspectives

Abstract Background Studies on the use of contraception in the Saudi community highlight the need for improving community knowledge about contraception, implementing guidelines, and restricting contraception dispensing. However, there is a lack of studies assessing the need for contraception protocols from obstetricians’ and gynecologists’ (Ob/Gyn) perspectives. This study aimed to assess the need for a contraception protocol from the perspectives of Ob/Gyn physicians. Methods Qualitative in depth, semi-structured interviews were conducted with a convenience sample that comprised physicians from the Department of Obstetrics and Gynecology in a tertiary teaching hospital. Interviews were audio recorded and transcribed verbatim and then analyzed using NVivo (QSR International) software. Results A total of 12 interviews were conducted and analyzed. Participants indicated a lack of prescribing restrictions and highlighted issues of low contraception literacy in Saudi communities, self-prescribing behaviors, health system organization, and physicians’ knowledge. Participants perceived the need for a contraception protocol guiding the prescribing process and patient counseling without restricting prescribing. Moreover, participants highlighted a number of factors affecting the development and implementation of such a protocol, including the availability of contraception, the need for research by physicians, patient factors, and the expected increased load on the hospital. Conclusions This research described current practices, showed the need for a contraception protocol, and highlighted the factors affecting the development and implementation of such a protocol

Asthma interventions in primary schools - a review

Objective To explore, in depth, the literature for evidence supporting asthma interventions delivered within primary schools and to identify any “gaps” in this research area. Methods A literature search using electronic search engines (i.e. Medline, PubMed, Education Resources Information Center (ERIC), International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Informit) and the search terms “asthma”, “asthma intervention” and “school-based asthma education program” (and derivatives of these keywords) was conducted. Results Twenty-three articles met the inclusion criteria; of these eight were Randomised Controlled Trials. There was much variety in the type, content, delivery and outcome measures in these 23 studies. The most common intervention type was asthma education delivery. Most studies demonstrated improvement in clinical and humanistic markers, for example, asthma symptoms medication use (decrease in reliever medication use or decrease in the need for rescue oral steroid), inhaler use technique and spacer use competency, lung function and quality of life. Relatively few studies explored the effect of the intervention on academic outcomes. Most studies did not report on the sustainability or cost effectiveness of the intervention tested. Another drawback in the literature was the lack of details about the intervention and inconsistency in instruments selected for measuring outcomes. Conclusion School-based asthma interventions regardless of their heterogeneity have positive clinical, humanistic, health economical and academic outcomes

Parents' asthma information needs and preferences for school-based asthma support

Abstract Objectives: This study sought to investigate parents' needs and preferences for school-based asthma support in Saudi Arabian primary schools. Methods: Semi-structured qualitative interviews were conducted in the period between November 2015 and February 2016, with a convenience sample that comprised Saudi parents and carers of children with asthma. Recruitment of participants was primarily driven through Saudi primary schools; passive snowballing and social networks were used to boost participation rates further. Interviews were audio-recorded, transcribed verbatim, translated and data were thematically organised using a latent content analysis approach. Results: Twenty interviews were conducted. Six themes emerged from the interviews and were grouped into three major categories: (1) general asthma management issues; (2) school-based asthma management issues; and (3) communication dissatisfaction. Participants expressed concern at schools' social and physical environments and a lack of confidence in the ability of schools to manage their child's asthma, especially when their child was ill. Most of the participants advocated for staff training and school community engagement to improve the management of asthma in Saudi primary schools. Conclusion: This research clearly describes a need for school-based asthma support, including asthma-related policies, procedures and education on asthma and first aid in Saudi primary schools. KEYWORDS: Asthma, carers, expectation, needs, parents, perception, perspective, preference, primary schools, school, suppor

Development and evaluation of a school-based asthma educational program

OBJECTIVES: To develop, implement, and evaluate the effects of a school-based asthma educational program on Saudi primary schools teachers' asthma awareness and competence in delivering asthma related first aid interventions. METHODS: An asthma educational intervention program entitled “School Asthma Action Program” (SAAP) was designed based on pedagogical principles and implemented among teachers randomly selected from girls' primary schools in Riyadh, Saudi Arabia. This pilot study employed a pre-test/post-test experimental design. A previously tested asthma awareness questionnaire and a custom-designed asthma competence score sheet were used to evaluate the effects of the educational intervention program on teacher's asthma awareness and competence in providing asthma related first aid interventions at schools. RESULTS: Forty-seven teachers from five different primary schools participated in the program. Of the 47 teachers, 39 completed both the pre- and post-program questionnaires. The SAAP improved teachers' awareness of asthma (teachers' median pre-program score was 11 (range 5–18) and their post-program score was 15 (range 7–18), p < 0.001) and their attitudes toward asthma management at schools (teachers' median pre-program score was 74 (range 15–75) and their post-program score was 75 (range 15–75), p = 0.043). Further, it improved teachers' competence in providing asthma related first aid interventions (teachers' mean pre-program score was 1.4 ± 2.3 and their mean post-program score was 9.8 ± 0.5, p < 0.001). After completing the SAAP, a high proportion of teachers reported increased confidence in providing care to children with asthma at school. CONCLUSION: School-based asthma educational programs can significantly improve teachers' knowledge of asthma and their competence in providing asthma related first aid interventions during emergencies

Burnout and Depressive Symptoms in Healthcare Professionals: A Cross-Sectional Study in Saudi Arabia

Objectives. The study objectives were to examine the prevalence of burnout among healthcare professionals, analyze the association of depression and burnout among healthcare professionals, and explore the factors related to burnout. Methods. A prospective cross-sectional study using a validated questionnaire was conducted among healthcare professionals in a tertiary teaching hospital in Saudi Arabia&rsquo;s central region. The Maslach Burnout Inventory (MBI) questionnaire was used to measure burnout through emotional exhaustion, depersonalization, and personal accomplishment. Descriptive and inferential statistics were carried out using SAS version 9.4. Results. The study sample was composed of 139 healthcare professionals. Around 48% of the study sample were nurses, 26% were physicians, 19% were pharmacists, and 6% were other healthcare professionals. About 61% screened positive for depression. Overall, one third of the participants had a high risk of burnout. Around 61.8% of the participants were in the high-risk group of the EE, 58.3% of the DP, and 41.0% of the PA subscales. Scores for the overall MBI were significantly different between various age groups, gender, those with social and financial responsibility, income, job titles, or years of experience. A higher risk of burnout in all subscales was observed among those with depression. Conclusions. A high risk of burnout was observed among healthcare professionals. The level of burnout was connected to workplace factors and the presence of depression. The burnout suffering among these healthcare professionals underlines the need to study further how to reduce the factors that contribute to burnout and the impact of interventions to reduce healthcare professionals&rsquo; burnout levels. The burnout scientific literature would benefit from further high-quality research with larger samples using longitudinal study designs to identify the causal risk factors