Effects of a Classroom-based Asthma Education Curriculum on Asthma Knowledge, Attitudes, Self-efficacy, Quality of Life, and Self-management Behaviors among Adolescents

Oct 15, 2026

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Asthma education interventions often target children and adults, with fewer programs designed for adolescents. This study used a nonequivalent control group with a delayed intervention to test a classroom-based high school curriculum grounded in social cognitive theory. Among 122 tenth-grade health academy students, 24 had doctor-diagnosed asthma. Curriculum recipients showed significant gains in asthma knowledge and self-efficacy. Attitudes toward asthmatics were generally favorable initially with a small decline after intervention, and quality of life improved slightly without significance. Findings support theory-based integration of asthma education into standard school curricula.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Adolescent asthma burden and risk

Evidence from national inpatient data

Rationale for school-based education

Prior program gaps and theoretical approach

Curriculum components and self-efficacy mechanism

Effects of a Classroom-based Asthma Education Curriculum on Asthma Knowledge, Attitudes, Self-efficacy, Quality of Life, and Self-management Behaviors among Adolescents Sally Fontamillas Shaw, Helen HoppMarshak, David T. Dyjack and Christine M. Neish ABSTRACT Asthma education interventions primarily target young children and adults, and a few target adolescents. Several constructs of the social cognitive theory were used to design a classroom-based high school asthma education curriculum and to determine if the curriculum would improve asthma knowledge and attitudes among 10th grade students, as well as improve the quality of life, self-efficacy, and self-management behaviors among asthmatic students. Using a nonequivalent control group design with delayed intervention (three-week delay) in one group, we surveyed a sample of 122 10th grade health academy students. Twenty-four students (20%) reported having doctordiagnosed asthma. Statistical data analysis determined that asthma knowledge mean scores and self-efficacy mean scores significantly improved for students who received the curriculum. Most students held favorable attitudes towards asthmatics before the intervention, with a slight decrease in positive attitudes after the intervention. There were also slight, insignificant improvements in quality of life among asthmatic students. This study demonstrated that the asthma curriculum improved knowledge among asthmatic and nonasthmatic students and self-efficacy among the asthmatic students. Asthma education, based on a theoretical framework, can be effectively incorporated into a traditional high school curriculum. INTRODUCTION Asthma is the leading chronic illness among children in the United States, affecting approximately 5 million under the age of 18.1 Furthermore, asthma is now the leading cause of school absenteeism and emergency room admission among children. Among adolescents aged 12-17, 136,000 in California missed one or more days of school per month due to asthma symptoms.2 Asthma among adolescents is also underdiagnosed,3 and the acceptance of diagnosis and compliance is poor.4 Consequently, some authors considered adolescent asthmatics to be a high-risk population.5,6 In a cross-sectional logistic regression analysis of the Healthcare Cost and Utilization Project’s dataset called Nationwide Inpatient Sample (NIS), adolescents 13 to 18 years of age were 1.22 times (95% CI= 1.05-1.43) more likely to have high-severity asthma than younger children 5 to 12 years of age, controlling for gender, geographic region, hospital location, bed size and season.7 Based on the literature, researchers are moving in the direction of implementing adolescent asthma health education in schools and determining what aspects of these interventions are effective. Schools, rather than hospitals, are prime settings for asthma health education for children and adolescents due to practicality and familiarity with the environment.8-10 Several asthma health education programs have been developed to change behaviors, such as avoiding allergens or regularly taking preventive medications, necessary for long-term control of asthma; 11-13 Sally Fontamillas Shaw, DrPH, MPH, is project director, Glendale Adventist Medical Center, 1509 Wilson Terrace, Glendale, California, 91206; E-mail: [shawsf@ah.org. Helen Hopp](shawsf@ah.org. Helen Hopp)[ ](shawsf@ah.org. Helen Hopp)Marshak, PhD, CHES, Loma Linda University, School of Public Health, Nichol Hall Room \#1511, Loma Linda, CA 92350. David T. Dyjack, CIH, DrPH, Loma Linda University, School of Public Health, Nichol Hall Room \#1202, Loma Linda, CA 92350. Christine M. Neish, PhD, MPH, CHES, RN, PHN, Loma Linda University, School of Public Health, Nichol Hall Room \#1711, Loma Linda, CA 92350. Sally Shaw, Helen HoppMarshak, David T. Dyjack and Christine M. Neish however, a majority of these programs targeted adult or child patients with asthma. Furthermore, the theme of most as

FAQs

What curriculum approach was used in the study, and what theory informed it?

The classroom-based high school curriculum was designed using constructs from social cognitive theory to target outcomes including knowledge, attitudes, and self-efficacy.

How was the study conducted and what was the intervention timing?

A nonequivalent control group design with delayed intervention was used, including a three-week delay for one group.

Which outcomes improved after the curriculum, and which showed little or no change?

Students who received the curriculum had significant improvements in asthma knowledge and self-efficacy. Quality of life showed slight, insignificant improvement, and attitudes had a small decrease in positive perceptions after the intervention.

Oct 15, 2026

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