SELF-MANAGEMENT IN CHILDREN WITH CHRONIC DISORDERS (ASTHMA, EPILEPSY, DIABETES): A RANDOMIZED FIELD TRIAL

Self-care and Self-help groups are promoted as appropriate for achieving improved outcome in Chronic Health Problem's management. We have developed a Training Model for pre-school and school-age children and their families, using Play and Role-Reversal techniques based on Self-Sufficiency and Self-Reliance. This model promotes a leading role for the children in the management of his own problem (self-management), with the Health Care Team's guidance, and the family learning to act facilitating the process. The goal is to achieve significant improvements in the child's functioning and quality of life. The program consisted in five weekly sessions held in a school, coordinated specially trained teachers. Children and parents met simultaneously in separate groups, joining at the end. They both were trained in identifying body signals, control of their environment, treatment's management, decisior-making and Self-Reliance habits. To assess the impact of the Program, a quasi-experimental, randomized Field Trial model was developed with 420 (4-12 years old) patients of the Children's Hospital R. Gutierrez (Respiratory, Nutrition and Neurology Departments). Of these, 212 were assigned randomly to Experimental (128, “Groups”) or Follow-up only (94, “Controls”). Preliminary results suggested a significant impact of the Program in attitudes and behaviours of the study children and their parents. In moderate to severe asthmatics, the children's severity according to the parents changed significantly(p=.0005). Unnecessary use of Hospital services also fell, as well as School Absenteeism (Exp: 11.3 to 6.9%; Cont: 9.2 to 11.6%). Parents showed more knowledge and less anxiety after the Program (Exp: Knowledge before 35%, after 61%; Cont: 33 and 29%) (Fear of child's death: Exp: Before 21.4% after 4.9%; Cont: 53.3% and 41.9%). There is also decreased sense of altered family dynamic, and increased (30 to 50% more) parental recognition of the child's protagonism. The Health Locus of Control changed also significantly in Experimental children (p=0.0015; Cont: p=0.10), which explains many of the positive changes operated. Preliminary results in Epilepsy and Diabetes showed a similar tendency.