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A study of the application and effective of case management in improving school and home health care for asthma children between urban and rural area.
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Objective It is a two-year project belonging in the series of evaluating the effects of case management model in improving school and home care for asthma children between urban and rural area. The main purposes of the first year study (the preparatory and developing stage) are to develop an appropriate case management model (also called care map) and instruments to use in different urban degree areas, and to design in-service training programs to school health nurses for enhancing their case management skills. As to the main purposes of the second year study (the executive and evaluative stage) are evaluating the effects of this case management model via a pre-test and post-post research design. A comparison between urban and rural area to identify problems and difficulties is also a key point of this study which can be as s base to spread in nationwild. After completing this study, the case management model, procedure, and instrument can be use in future study and practice, in addition, they can be as references for making health and educational policy.
Results - In the first year, we already developed various instruments including a case management model of asthma children (i.e. care map), records, and questionnaire. In developing these instruments, we not only collected qualitative data to understand asthma children, their parents or caregivers, teachers, and school nurses opinion and acceptance of asthma, but combined with reviewing literatures, jury opinion and focus group, and personal interview. The care map and various records had identified by professional audit and pilot test. For questionnaire, a total of twelve scales to four target groups (i.e. asthma children, their parents or caregivers, teachers, and school nurses) were developed in the first year to assess and evaluate their knowledge, attitude, and ability of caring asthma children or themselves (for asthma children). All scales had face validity, and the content validity index (CVI) were above 0.74. In reliability, the internal consistency (alpha) coefficients were examined in this study. The Cronbachs alpha coefficients ranged from 0.69 to 0.91 in four asthma caring knowledge scales (including asthma children, their parents or caregivers, teachers, and school nurses); 0.81 to 0.91 in four asthma caring ability scales. As to four attitude scales, lower alpha coefficients revealed in asthma children (0.42) and their parents (0.58), however, satisfactory values showed in teacher (0.75) and school nurses (0.91).
Conclusion we finish all tasks in the first year (including developing case management model, various instruments, questionnaire, designing the content of in-service training program, and job descriptions). All of them will be used in the second year study to evaluate the effects of this case management model intervention.
Key word: asthma children, case management, school health, home health, effect evaluation, urban and ural area.