CLAHRC researchers based at Queen Mary University of London launched the My Asthma in School programme this week – an initiative that aims to improve the self-management of the respiratory condition by school children.
Developed by researchers at the University’s Blizard Institute, the programme will use films and apps in educational workshops and theatre performance to improve asthma control and peer support for asthma in London secondary schools.
The programme has been approved and supported by Sadiq Khan, Mayor of London, who himself lives with the condition.
He said: “The Greater London Authority and I believe that the ‘My Asthma in School’ programme is likely to promote the necessary education young people require to effectively self-manage their asthma.”
He added: “I encourage all London secondary schools to take part in this programme.”
Asthma affects approximately 1 in 11 children and young people in the UK; and young people with asthma have higher rates of school absences and visits to their doctor or the hospital. According to the data collected for the study, nearly half of young people (aged 11-18 years) with asthma did not have good control over their condition [Harris K et al,J Asthma 2017,54(10):1033-1040].
Dr Gioia Mosler, Outreach and Learning Manager for the ‘My asthma in school project’ (below, left) was at the launch event and said:
“The number of deaths from asthma in the UK rank among the highest in the EU. Many of these deaths could be prevented with better self-management.”
She added: “We want to improve the ability and motivation of young people to self-manage their asthma so they can take control of their condition.”
The research team’s results showed that young people with asthma often faced many barriers to addressing their condition, including lack of knowledge, or embarrassment to use their asthma inhaler in front of others. Based on these findings, as well as behavioural change theories, the researchers involved young people to develop a series of engaging teaching elements for an intervention, including several games, apps and videos: www.myhealthinschool.org.
The intervention will also deliver an interactive theatre performance, lasting approximately two hours, to help raise awareness of asthma among peers. The performance has been developed with partners at Greenwich and Lewisham Young People’s Theatre [Mosler G et al,Lancet 2017,391(10118):303–304].
Dr Mosler added: “The theatre intervention addresses asthma from a new angle, focusing on peer awareness and support around young people with asthma. The theatre addresses barriers related to a perceived stigma around asthma in peers, young people with asthma reported during our initial data collection.”
My asthma in School is one of the first school-based interventions for asthma self-management in the UK. Similar trials have been undertaken outside the UK, however, given that the health and education systems differ, results from these interventions may not be transferable to a UK setting.
The intervention will be trialled in London during the next few months. Given a positive result of this intervention it could be adopted as a wider programme to improve asthma in young people.
The programme is run as part of the My Health in School initiative based at the Blizard Institute within Queen Mary University of London which aims to improve life and health of young people at school. The team works with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.
Schools are encouraged to get in touch to join our research – email: firstname.lastname@example.org.
Harris, K.; Mosler, G.; Williams S. A.; et al. (2017): Asthma control in London secondary school children. Journal of Asthma; 23: 1–8.
Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev. 2015;(4)
Mosler G. & Euba T. (2017): Taking control through drama. Lancet; 391: 10118, p303–304.
After 70 years, does the NHS have a future?
Never a week goes by without claims of another ‘crisis’ engulfing the NHS: insufficient resources, dispirited staff, poor safety, waiting times, inadequate social care and more.
To mark the 70th birthday of the NHS, our colleagues at the London School of Hygiene & Tropical Medicine (LSHTM) are hosting a Question Time event with an expert panel from nursing, medicine, health policy and research to focus on the challenges and prospects for the future.
If you register to attend this free debate you can submit questions for the panel and contribute to the discussion on the day if you wish to.
Panellists for this event are –
- Dame Donna Kinnair, Director of Nursing Policy & Practice, Royal College of Nursing
- Nigel Edwards, Chief Executive, Nuffield Trust
- Jane Dacre, President, Royal College of Physicians, London
- Martin McKee, Professor of European Public Health, LSHTM
It will be chaired by Sir Nick Black, Professor of Health Services Research, LSHTM
It is free to attend but registration is required, please follow the link below.
London School of Hygiene & Tropical Medicine
John Snow Lecture Theatre
Date and time
Tuesday 3 July 2018
17:30 – 18:30
New CLAHRC research has highlighted a lack of guidance for health and social professionals who encounter children exposed to domestic violence.
Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. Children can be directly impacted – leading to emotional and behavioural problems and risks of physical injury and death when children are caught up in the violence between adults. Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences. Health and social care workers are often the first professionals to have contact with a child experiencing these situations.
In a collaboration with CLAHRC East of England and international colleagues from the McMaster and Western Universities in Canada we examined the evidence on child, parent and professional views on acceptable approaches to identifying and responding to children exposed to domestic violence.
The resulting research paper, published in BMJ Open, highlighted conflicting views of children and mothers on the one hand and professionals on the other when it came an ideal response. Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals preferred to engage with children via the parent and they often did not perceive children exposed to domestic violence as patients or clients in their own right.
Guidelines for health professionals who encounter women who have experienced domestic violence provide various questions and prompts they can use in discussions, and a set of principles to follow. There are no equivalent recommendations on how to identify and respond to children exposed to domestic violence and limited evidence on which to base future guidance. Our analysis also revealed that professionals were not happy with the existing safety guidelines for children and mothers exposed to domestic violence and wanted changes.
The research was funded by the Public Health Agency of Canada through funding to the VEGA (Violence, Evidence, Guidance and Action) project. The VEGA Project is part of the Canadian Government’s Public Health Response to Family Violence. This research will inform the development of public health guidance, protocols, curricula and tools for health and social service providers. The research was supported by the NIHR CLAHRC North Thames and NIHR CLAHRC East of England.
Resources supporting this new research include a blog in The Conversation by lead researcher Dr Natalia Lewis, and we have worked with CLAHRC East of England on a joint BITE – a summary of the research with key learning for busy professionals interested in this work.
Read the paper
Natalia V. Lewis, Gene S. Feder, Emma Howarth, Eszter Szilassy, Jill R. McTavish, Harriet L. MacMillan, Nadine Wathen.
BMJ Open 2018. Published in BMJ Open. April 2018. Doi:. http://bmjopen.bmj.com/content/8/4/e019761
Read a BITE sized summary
Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.
The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.
Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.
Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.
The World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support.
But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. So far, there has also been only limited evidence on which to base future guidance.
Now researchers at universities in the UK (Bristol, Queen Mary and Cambridge) and Canada (McMaster and Western) have combined existing evidence on the best ways to identify and respond to children experiencing domestic violence. This synthesis, the first of its kind, integrates findings from 11 studies with 42 children, 220 parents, and 251 health care and social services professionals.
We found that study participants’ opinions were strikingly consistent, and matched the LIVES principles. Children, parents (mostly mothers) and professionals agreed that identification of the problem should happen in the context of a good patient-professional relationship, and in a safe and supportive environment.
Health care professionals should enquire about the child’s safety when they see clinical signs of domestic violence and abuse in children. The ideal initial response should include emotional support, discussion about domestic violence and advice on local specialist services.
We also discovered that a professional’s ability to identify and respond to children’s exposure to domestic violence was heavily influenced by constraints within the health and social service system. Lack of time, funding cuts and poor inter-agency collaboration all have an impact. Professionals needed more training and resources to be able to respond to these children and their families in an appropriate and safe way.
However, there was a difference of opinion when it came to engaging directly with children and managing their safety.
A direct approach?
Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals, on the other hand, preferred to engage with children via the parent – and did not perceive children exposed to domestic violence as patients or clients in their own right. Also, professionals were not happy with existing safety guidelines and practices for children and mothers exposed to domestic violence. These elements are certainly subjects for future research and training.
Given the scale of the problem, and the long-term emotional, behavioural and physical impacts on children, we hope that the results of this study can form the basis of new, internationally agreed guidelines.
Our research findings have already been used to inform point-of-care responses to adults and children in Canada’s VEGA (Violence, Evidence, Guidance, Action) Project. That program is already developing the “Recognising and Responding Safely to Family Violence” Handbook for health and social care professionals.
And we hope our evidence will inspire development of professional training and resources elsewhere – so that front line practitioners feel better equipped to appropriately and safely respond directly to the needs of children. Too many children’s lives and futures could depend upon it.
Part of the CLAHRC’s mission is to raise awareness of new research evidence, and get it to the front-line where it can used by NHS staff. We are working with our host Trust NHS Bart’s Health to translate the new knowledge we generate into everyday practice among NHS professionals.
Bart’s Education Academy has developed an eCPD app available to download for free for users of Android and iPhone smartphones. The eCPD app aims to reduce the time staff have to leave the frontline to attend training courses in person, and give them more flexible learning they can fit around their busy schedules. The app allows staff to log in and create personal and professional development plans (including mandatory training) and optional learning modules. Once completed a notification is sent to both the member of staff and their supervisor, to show they have carried out the necessary training and are credited with CPD points where appropriate.
The CLAHRC has provided learning modules focused on our research findings, and more of our work will appear on the App in the near future.
We are now rolling out some of our popular CLAHRC Academy courses so that they can be accessed via the App – our Academy Director Dr Nora Pashayan (below right) and Academy Teaching Fellow Dr Silvie Cooper (below left) recently met Director of Academic Health Sciences at Barts Health NHS Trust Professor Jo Martin to launch our Introduction to Evaluation course via the App.
The Barts Education Academy provides clinical placements for 2,500 medical undergraduate students and trains 1,040 junior doctors, over 800 children, adult nursing and midwifery students and 275 allied health professionals. The Education Academy offers resuscitation skills training, moving and handling, simulation and clinical skills training and a range of skills based short courses, as well as ensuring the trust achieves high levels of compliance for its statutory and mandatory training.