He Kura: Improving Asthma Support for School Children

Phase 2: The overall duration of the intervention period will be 8 months. Engagement: Initial engagement will involve senior members of the research team meeting with the school principal and the board of trustees of individual schools who have indicated an interest in the study, to provide an overview of the intervention and to explain what it may involve for their school. Identifying Needs: Following this initial meeting, a workshop/meeting will take place with the principal and other available staff members e.g. admin staff, teachers, caretakers and members of the research team to identify the potential issues affecting asthma management in individual schools. Research staff will establish what support the school has e.g. access to a public health nurse; asthma first aid training and what services are available within the community. The schools level of community engagement will be assessed through a short series of questions with the school’s principal. Rollout: Using the information obtained from this meeting, researchers will work with individual schools to help customise the asthma toolkit suited to their needs. School principals can prioritise their schools needs if it is not possible to implement all of the intervention components at once. Researchers will explain in detail the processes involved with each intervention component. Individual schools can choose whether to include or exclude aspects of the following components from the toolkit intervention; school environmental assessments, school education, community engagement and education, school policy guidelines, staff training and linkages to healthcare providers. Evaluation: A process evaluation will examine the implementation of the intervention to determine whether it was implemented as intended. Members of the school community including, parents, board of trustees, principals, teachers, support staff and key-informants e.g. public health nurses, Maori health providers and GP’s will be encouraged to provide both qualitative and quantitative feedback. Following the intervention surveys will be conducted to capture a wide range of views. Semi-structured interviews and focus groups will also be offered to members of the school community to determine which elements of the intervention worked well and for suggestions regarding modification. Complex interventions work best if they are tailored to local contexts rather than being completely standardised, hence this design allows for schools to customise the way in which they implement the Toolkit while following basic principles underpinning it. Study staff will work individually with intervention schools assisting them to use and customise the toolkit. Each school will receive both printed and electronic copies of the toolkit resources. Intervention Components 1. Case Identification An important component of the toolkit will be mechanisms to enable a school to identify children with asthma. This is also a necessary component of our outcome assessment measures i.e. we need to identify children with asthma in order to capture their baseline information, therefore case identification will be completed within all intervention schools. Total days away from school will be collected from school records as the primary outcome. Generally, school records often do not record the reason for absence. The total number of days away from school from the previous year will also be documented in order to compare absences pre and post intervention. 2. Medication Management Policies will be recommended to intervention schools encouraging schools to allow students to have easy access to their asthma medication throughout the school day. Emergency bronchodilator medication will be available within asthma emergency kits at intervention schools. School staff will be educated on how and when to use this medication. These policies aim to reduce severe asthma symptoms and to promote full activity participation for students with asthma. 3. Staff Training Intervention schools will be offered asthma education training either in the form of online training or through asthma education sessions with an asthma educator. The aim of the staff training is to increase staff awareness around asthma triggers, symptoms and management. As outlined in the School Policy Guidelines, school staff will be encouraged to receive education on acute asthma management once or twice a year. 4. Student Education Students will be provided with an educational asthma activity workbook to take home and complete the activities with their parents/whanau. Researchers are available to answer any questions they might have and feedback on the usefulness of this activity book will be sought at the end of the trial. 5. Community Engagement and Education The nature of this component will be determined in collaboration with individual schools. It is likely that the community engagement and education will occur at pre-established events such as whanau evenings or parent/teacher evenings. This component of the intervention is designed to increase the knowledge, skills and confidence of asthma for whanau and the wider community in a relaxed and informal environment. Each school’s level of community engagement will also be assessed; board members, teachers and principals will be asked the following questions: Do you interact with parents or wider whanau? What type of events do you provide to support parents/whanau engagement (e.g. Parent Teacher evenings, fundraisers, galas, hui, sports events)? Are these events well attended by whanau/families? If so why? Do community organisations support your school’s community health worker, sports clubs, and farmers? 6. Linkages to Healthcare Providers Linkages to healthcare providers will also be developed in collaboration with intervention schools. Schools will decide the best course of action regarding individual asthma plans, whether parents are responsible for obtaining these from the GP and giving a copy to the school or if schools should get a copy directly from the GP. Research teams will make contact with appropriate healthcare providers within the community e.g. GPs, pharmacists and public health nurses to help establish better communication between medical professionals, schools and whanau. 7. School Environment Classroom allergen testing and school environmental assessments will be carried out at the beginning of the intervention. Classroom allergen testing will involve researchers obtaining a vacuumed sample from the floor surface of each classroom to test for allergens know to trigger asthma. The School Environmental Assessment involves researchers assessing each classroom for potential asthma triggers; the questionnaire assesses the type of floor coverings, types of pets in the classroom etc. A broader assessment of the whole school is also offered with researchers assessing the school grounds for environmental factors such as types of plants on the schools grounds, chemicals used in the school pool etc. In order for schools to minimise student exposure to potential asthma triggers, recommendations will be given to individual schools based on the results of their classroom allergen samples and environmental assessments. Dust samples will be collected from all classrooms and halls of each school by standardised vacuuming techniques. For allergen levels, the dust samples will be extracted with phosphate-buffered saline and the major allergens to house dust mite, cat, dog, mouse, rat, cockroach, horse and cow quantified by established commercial monoclonal and polyclonal enzyme-linked immunoassays as previously described. Bacterial endotoxin and fungal B-glucan will be quantified in dust extracts by specific Limulus amebocyte lysate assays as previously described. Additionally, we will inspect the classrooms for visible mould, note the presence of carpets or rugs, type of heating appliance, and occupancy. 8. Process Evaluation A process evaluation examines the implementation of a programme to determine whether it is being implemented as designed and planned, and what aspects of the programmes operating environment help or hinder programme implementation and the subsequent achievement of outcomes. Qualitative Experiences This will include acceptability of the toolkit and participant experiences with the trial and community engagement as well as any suggestions for modification to the intervention prior to recommendations for National use. Data Collection (Quantitative): A brief survey will be conducted post-intervention in order to capture a wider range of views from all categories of participants. This will allow health professionals, parents and school staff to feedback their views and thus contribute to evidencing what worked and what could be improved. Data collection (Qualitative): This will involve focus groups and semi-structured interviews (n= 5-10 per category, per school) allowing participants to choose their preferred method.