More than 1.5 billion people worldwide have chronic respiratory illnesses, and more than 4 million deaths occur worldwide each year from this group of diseases [1]. With the onset of symptoms, the disease has a profound effect on the patients' life course and affects their health, family life, group activity, social and work performance. [6] Thus, this group of patients is unaware of their disease [7]. Education plays an important role in improving the quality of life of patients with asthma [8]. Raising patients' awareness of self-care is one of the most important ways to control this disease. Self-care education, instead of relying on patient disabilities, can emphasize potential and reduce subtle costs, improve quality of life, and improve daily living activities [9]. Studies show that educational programs, despite their great variety in form, environment, target group, goals, teaching style, and outcomes evaluation, significantly improve knowledge, develop a positive attitude to asthma and increase its control skills, reduce school absenteeism, increase physical activity, increase sense of control over the disease and decrease the use of health care services [23].

 

The present study is a clinical trial. The samples of this study included 104 patients with asthma who referred to Lung Clinic of Shahid Beheshti Hospital in Hamadan. They were selected by convenience sampling and randomly divided into two groups of experimental and control (groups of 52 individuals).
Inclusion criteria included having an asthma approved by a physician, lack of experience in formal training such as workshops and research on asthma, having other chronic illnesses, age 20-65 years, no communication problems like deafness and literacy. Exclusion criteria were exclusion for any reason during the study such as death, relocation and unwillingness to continue in the study, patients with severe asthma who were admitted to the ward.
Three questionnaires used in this study were: a) demographic variables questionnaire; b) self-knowledge questionnaire about asthma; c) attitude questionnaire for asthma.
The demographic questionnaire included age, gender, occupation, education level, marital status, years of asthma and smoking. The Asthma Knowledge Questionnaire was developed by Mazloumi et al. and its reliability based on Cronbach's alpha coefficient was reported 0.71 [28]. The validity of the questionnaire has been confirmed by experts based on content method [28]. The questionnaire consists of 3 subscales and 32 questions. A total of 8 items for disease recognition subscale, 8 items for Drug Recognition subscale, and 16 items for asthma-inducing agents subscale were scored; the final score was measured as 0–32. The higher the score, the greater patient awareness. The manner of answering the questions was also determined by the choice of three options: yes, no and I don’t know. For each correct answer, a score of one was assigned and a score of zero for the answer I don't know or false. The reliability of this questionnaire in the present study was 0.88.
The Asthma Attitude Questionnaire was also developed by Mazloumi et al. and its reliability was 0.71 based on Cronbach's alpha coefficient [28]. The validity of the questionnaire based on content method has been confirmed by experts [28]. This is a seven-question questionnaire. Questions are asked in which the patients state their agreement or disagreement with the terms specified. The answers are on a Likert scale, from (1) strongly disagree to (5) strongly agree. The score obtainable in this construct is in the range of 7-35. A score of 5 was completely acceptable and a score of 1 was completely opposite. The reliability of this questionnaire was 0.87 in Cronbach's alpha.
After providing necessary explanations about the research, written consent was obtained from patients and demographic information of both groups was recorded through interview. Then the knowledge and attitude of the patients were measured using the questionnaires. Patients in the experimental group were divided into 2 to 5 groups. PowerPoint software and lecture were given to the experimental group in four sessions of one session per week. The duration of each session was 60 minutes. Coordination was done to hold meetings by phone or SMS. Training sessions were held in the clinic class of Shahid Beheshti Hospital.

Of the 104 asthmatic patients included in the study, 52 were in the experimental group and 52 in the control group. The distribution of patients in the two groups was not significantly different in all demographic characteristics. There was a statistically significant difference between the mean score of knowledge and the dimensions of this questionnaire in the pre- and post-intervention groups, while in the control group, in relation to the recognition of the triggers and the general awareness of the asthma, there was a significant difference before intervention, but no significant difference was found in disease and drug cognition (P<0.05). The results of independent t-test showed that there was no significant difference between the mean of pre-intervention knowledge between the experimental and control groups (P=0.98). Whereas the same test showed a significant difference between the two groups after the intervention (P<0.001). There was no significant difference between the mean scores of attitude before intervention between the experimental and control groups (P=0.96), while the mean of attitude scores after the intervention was significant (P<0.001) (Table 1).
 

Table 1. Comparison of mean knowledge and dimensions of knowledge and attitude between experimental and control groups before and after intervention

Self-care education has increased the awareness and attitude of patients with asthma. The present study showed that although there was no significant difference in the mean score of asthma patients in the experimental and control groups at the beginning of the study, eight weeks after the intervention there was a significant increase in the mean score of asthma patients in the experimental group. The results of the present study are in line with the results of a study conducted by Zigheymat et al. which investigated the effect of education on self-care knowledge and behaviors [29]; they showed that training patients undergoing coronary artery bypass surgery increased their self-awareness and self-care behaviors. [29]. The results of a study by Baba Beigi et al. (2014) in Shiraz showed that educational programs are effective in raising awareness, improving self-care and controlling harmful habits in patients with hypertension [30]. The results of Goodarzi et al.'s study, as well as Baghiani Moghadam et al.'s, showed that education significantly improved the mean score of awareness in patients with type 2 diabetes [32, 31]. While the results of Bidi et al.'s study showed that educational program did not have a significant effect on the mean knowledge of test subjects [26]. One of the most important reasons for the differences between these two studies can be related to the type of intervention and their volume. In the Bidy et al. study, the sample size was very small, only 20 patients in each group, and given the large size of the questionnaire, this sample size as a confounding factor could easily disrupt the results. Therefore, sufficient sample size should be determined in future studies that are planned. Also, this study shows that patients receive 2 and a half hours of training, which is a very short time.

 

According to the results of this study, it can be said that self-care education increases the knowledge and attitude of patients regarding proper use of drugs, sprays, and avoidance of stimulant factors. The care and treatment team in our country should pay more attention to education about patients with chronic diseases such as patients with asthma.

 

This study was approved by the Ethics Committee of Hamadan University of Medical Sciences and Health Services under license no. 5195/4/73/16 and IR.UMSHA.REC.1396.725 and registered by Iranian Registry for Clinical Trial center with the code: IRCT2016.110025929N
We would like to thank the Honorable Research Assistant of Hamadan University of Medical Sciences as well as the staff of Shahid Beheshti Hospital and all the participating patients and those who helped with this study for their sincere cooperation.

 

The authors declared no conflict of interest.