Acta Paediatr 81: 413-16. 1992
Danish primary schoolteachers’ knowledge about asthma: results of a questionnaire LP Madsen, K Storm and A Johansen Department of Paediatrics, Randers Centrul Hospital, Randers. Denmark
Madsen LP, Storm K, Johansen A. Danish primary schoolteachers’ knowledge about asthma: results of a questionnaire. Acta Prediatr 1992;81 :413- 16. Stockholm. ISSN 0803-5253 We present an anonymous questionnaire inquiry involving 334 primary schoolteachers in the Randers area with the purpose ofelucidating teachers’ knowledge about asthma. To a series of statements about asthma, the teachers answered yes, no or don’t know. A limited knowledge of different aspects of asthma in children was found, although 57% had asthma children in their classes. Specially limited was knowledge about medical treatment. Five percent had received proper instruction about asthma and had a significantly better knowledge of medical treatment ( p < 0.001-0.05). Only 57% knew that wheezing after physical exertion is a strong indicator of asthma and only 33%0knew that exertion in cold weather increases the risk of an attack. It is recommended that instruction in children’s diseases, especially asthma, is introduced in teacher training colleges. 0 Asthma in schoolchildren, schoolteachers LP Madsen, Otto Rudsgade 44A, dk-8200 Aarhus N . Denmark
Asthma is the most frequently occurring chronic disease in childhood (1). Between 4 and 10% of all schoolchildren are affected to a major or minor extent by the disease (1-5). Asthma is a frequent cause of absenteeism and is probably the cause of approximately one-third of all absences due to chronic disease ( 3 , 6 ) .During school hours, teachers have prime responsibility for supervising asthma children and may often be in a position to decide upon the extent of physical activities and the extent of both prophylactic and acute treatment. About 24% of parents are dissatisfied with the management of children with asthma in schools ( 5 ) . The purpose of this examination was to elucidate the level of knowledge about asthma among teachers, to identify areas with especially limited knowledge, to elucidate teachers’ attitude to treatment during school hours, as well as the need for supervision of teachers.
Materials and methods The examination was an anonymous questionnaire inquiry involving teachers at the 13 primary schools in the county of Randers which is well-described and has a population combination largely corresponding to the national level (7). For reasons of principle two schools did not want to participate. In October and December 1990 a visit was made to 1 1 schools (5200 pupils, 458 teachers) during the lunch break. Due to timetabled days off, postgraduate courses, school yard duty, etc. only 334 teachers were present at the visits. After a brief introduction, questionnaires were given to all the
teachers present. The questionnaire consisted of a series of statements about asthma that were to be answered with a yes, no, or a don’t know. The response among the teachers present was 100% but not all teachers answered all questions. The replies were judged as either correct or incorrect from the authors’ point of view (6). At the statistical assessment, Fisher’s exact test (two-tailed) was applied.
Results Table 1 shows the teachers’ answers to questions of a general nature concerning asthma. No significant connection was found between the number of correct answers and previous instruction about asthma. Table 2 shows the teachers’ understanding of circumstances related to children’s participation in sports. Eighty percent had the correct opinion that asthma children should be encouraged to take active part in sports. Only between 22 and 33% had the correct opinion about the effect of weather conditions on asthma. A significant correlation was found between previous instruction about asthma and a correct answer to question 1 and 4 (peO.01-0.05). Table 3 shows the answers concerning medicamental treatment. It appeared that the teachers had only a limited knowledge. Best known to the teachers were the frequently used bronchodilators Ventolin and Bricanyl, whereas Becotide and Lomudal were almost unknown to the teachers. Teachers previously instructed about asthma were found to have significantly more correct answers to all but questions 5 and 12 (p=O.OO1-0.05).
4 14
ACTA PEDIATR R I ( I992
LP Madsen el a/.
Table 1. Teachers' general knowledge about asthma (n = 334). (Percentage of correct answers.)
Teachers' answers
I. 2. 3. 4. 5. 6. 7. 8. 9.
Between 5 and lo'%,of all children suffer from asthma Asthma is frequently seen through several generations ("is hereditary") Asthma children often suffer from hayfever, too Asthma children often come from low social status homes Asthma children often have over-protective mothers Asthma may lead to low growth in children Asthma is affected by emotional factors Children may die from asthma In Denmark, about 5 to 10 children die every year due to asthma
Correct answer
Correct
Incorrect
Don't know
Correct Correct Correct Incorrect Incorrect Correct Correct Correct Correct
I99 (60.1) 273 (82.2) 256 (77.6) 256 (77.1) 203 (61.7) 70 (21.2) 239 (72.0) 241 (72.8) 110 (32.9)
38 21 19 30 54 123 45 28 26
94 38 55 40 72 137 48 61 I98
Table 2. Teachers' knowledge about asthma and sports (n= 334). (Percentage of correct answers.)
Teachers' answers Correct answer
I . Swimming is a good sport for asthma children 2. Asthma children should be encouraged to take active part in sports 3. Teachers should ensure that necessary medicine is taken before physical exercise 4. Asthma medicine taken before exertion in connection with sports may often prevent an attack 5. Sports in rainy weather increases the risk of setting off an attack 6. Sports in cold windy weather increases the risk of setting off an attack 7. Wheezing after exertion is an asthma indicator 8. Children with a well-treated asthma generally show poorer performances in physically demanding sports
Correct
Incorrect
Don't know
Correct Correct Correct
190 (57. I ) 267 (80.4) 190 (57.1)
37 9 42
I06 56 101
Correct
I90 (57.1)
15
I28
74 (22.2)
122 93 83
137 I30 60 82
Incorrect Correct Correct Incorrect
1 I 1 (33.2)
188 (56.8) 88 (26.3)
164
Table 3. Teachers' knowledge about treatment of asthma children (n = 334). (Percentage of correct answers.)
Teachers' answers
I. 2. 3. 4. 5. 6. 7. 8. 9.
Antibiotics (penicillin, etc.) are applied in asthma treatment Ventolin"/Bricanylb are airway opening medicaments Ventolin/Bricanyl are immediately effective Becotide' and Lomudald are immediately effective against wheezing Becotide and Lomudal are effective against respiratory infections Ventolin/Bricanyl may lead to increased pulse (palpitation) Ventolin/Bricanyl may lead to shaky hands Ventolin/Bricanyl are effective against respiratory infections The following medicament must be taken regularly (also during attack-free times) Ventolin Becotide Lomudal Bricanyl 10. The following medicaments must be taken at attacks (wheezing) Antibiotics Lomudal Ventolin Becotide Bricanyl I I . Ventolin/Bricanyl are the best medicaments before physical exercise 12. Ventolin/Bricanyl in urine leads to disqualification of athletes (doping-tests)e
Correct answer
Correct
Incorrect
Don't know
Incorrect Correct Correct Incorrect Incorrect Correct Correct Incorrect
188 (56.5) 188 (56.3) 160 (48.2) 18 (5.1) 28 (8.4) 72 (21.6) 57 (17.1) 44(13.3)
18 0 6 41 32 16 43
I27 I46 166 272 272 252 26 1 244
Incorrect Correct Correct Incorrect
19 (5.7) 28 (8.4) 33 (9.9) 17(5.1)
53 9 8 41
262 295 29 I 276
Incorrect Incorrect Correct Incorrect Correct Correct Correct
63 (19.0) 12 (3.6) 67 (20.1) 9 (2.7) 55 (16.6) 56 (16.8) 16 (4.8)
3 24 5 20 7 9 33
265 296 26 I 30 I 270 269 283
10
a Salbutamol; terbutaline; beclometasone dipropionate; sodium chromoglycate; salbutamol and terbutaline in urine means disqualification of athletes. This is not the case for asthma patients in inhalation treatment, provided sports festival medical officers have been notified about this before contest.
4I5
Schoolreachers’ knowledge about asthma
ACTA PEDIATR 81 (1992)
Table 4. Teachers’ knowledge about asthma and school attendance (n =334). (Percentage of correct answers.)
Teachers’ answers Correct answer I . An asthma child’s absence is a good indicator of the severity of the disease 2. Having attacks during school hours make children more afraid of further attacks 3. Asthma children have the same 1Q level as other children
Correct
Incorrect
Don’t know
Correct Correct
89 (27.5) 258 (77.7)
136 31
99 43
Correct
322 (97.0)
2
9
Table 5 . Teachers’ knowledge, experiences, and attitudes about asthma and treatment (n = 334). (Percentage of correct answers.)
Teachers’ answers ~
I. 2. 3. 4. 5. 6. 7. 8. 9. 10. I I. 12.
Do you think you know enough about asthma in children? Did you ever receive instruction about asthma? Did you ever notice that asthma children in any way differ from other children? Would you permit an asthma child to keep his medicine on him during school hours? Would you or have you instructed/advised a child in the use of his inhalation medicine (asthma spray)? Have you yourself got an asthma child? Do any of your close relatives suffer from asthma? Do or did you ever suffer from asthma yourself? Do you or did you ever have an asthma child in your classes? Have you ever had contact with parents due to children’s asthma? Is there a school nurse permanently or partially attached to your school? Is there a school doctor permanently or partially attached to your school?
Table 4 shows the teachers’ knowledge about asthma and school attendance. No significant correlation was found between previous instruction and number of correct answers. Table 5 shows teachers’ experience with and attitudes to asthma among schoolchildren. Only approximately 6% thought they knew enough about asthma, a figure which corresponded to the number of teachers who had received proper instruction. Twenty-one percent had supervised or intended to supervise children in the use of inhalers. Among those who had been instructed, significantly more were willing to d o this ( p
Danish primary schoolteachers’ knowledge about asthma: results of a questionnaire LP Madsen, K Storm and A Johansen Department of Paediatrics, Randers Centrul Hospital, Randers. Denmark
Madsen LP, Storm K, Johansen A. Danish primary schoolteachers’ knowledge about asthma: results of a questionnaire. Acta Prediatr 1992;81 :413- 16. Stockholm. ISSN 0803-5253 We present an anonymous questionnaire inquiry involving 334 primary schoolteachers in the Randers area with the purpose ofelucidating teachers’ knowledge about asthma. To a series of statements about asthma, the teachers answered yes, no or don’t know. A limited knowledge of different aspects of asthma in children was found, although 57% had asthma children in their classes. Specially limited was knowledge about medical treatment. Five percent had received proper instruction about asthma and had a significantly better knowledge of medical treatment ( p < 0.001-0.05). Only 57% knew that wheezing after physical exertion is a strong indicator of asthma and only 33%0knew that exertion in cold weather increases the risk of an attack. It is recommended that instruction in children’s diseases, especially asthma, is introduced in teacher training colleges. 0 Asthma in schoolchildren, schoolteachers LP Madsen, Otto Rudsgade 44A, dk-8200 Aarhus N . Denmark
Asthma is the most frequently occurring chronic disease in childhood (1). Between 4 and 10% of all schoolchildren are affected to a major or minor extent by the disease (1-5). Asthma is a frequent cause of absenteeism and is probably the cause of approximately one-third of all absences due to chronic disease ( 3 , 6 ) .During school hours, teachers have prime responsibility for supervising asthma children and may often be in a position to decide upon the extent of physical activities and the extent of both prophylactic and acute treatment. About 24% of parents are dissatisfied with the management of children with asthma in schools ( 5 ) . The purpose of this examination was to elucidate the level of knowledge about asthma among teachers, to identify areas with especially limited knowledge, to elucidate teachers’ attitude to treatment during school hours, as well as the need for supervision of teachers.
Materials and methods The examination was an anonymous questionnaire inquiry involving teachers at the 13 primary schools in the county of Randers which is well-described and has a population combination largely corresponding to the national level (7). For reasons of principle two schools did not want to participate. In October and December 1990 a visit was made to 1 1 schools (5200 pupils, 458 teachers) during the lunch break. Due to timetabled days off, postgraduate courses, school yard duty, etc. only 334 teachers were present at the visits. After a brief introduction, questionnaires were given to all the
teachers present. The questionnaire consisted of a series of statements about asthma that were to be answered with a yes, no, or a don’t know. The response among the teachers present was 100% but not all teachers answered all questions. The replies were judged as either correct or incorrect from the authors’ point of view (6). At the statistical assessment, Fisher’s exact test (two-tailed) was applied.
Results Table 1 shows the teachers’ answers to questions of a general nature concerning asthma. No significant connection was found between the number of correct answers and previous instruction about asthma. Table 2 shows the teachers’ understanding of circumstances related to children’s participation in sports. Eighty percent had the correct opinion that asthma children should be encouraged to take active part in sports. Only between 22 and 33% had the correct opinion about the effect of weather conditions on asthma. A significant correlation was found between previous instruction about asthma and a correct answer to question 1 and 4 (peO.01-0.05). Table 3 shows the answers concerning medicamental treatment. It appeared that the teachers had only a limited knowledge. Best known to the teachers were the frequently used bronchodilators Ventolin and Bricanyl, whereas Becotide and Lomudal were almost unknown to the teachers. Teachers previously instructed about asthma were found to have significantly more correct answers to all but questions 5 and 12 (p=O.OO1-0.05).
4 14
ACTA PEDIATR R I ( I992
LP Madsen el a/.
Table 1. Teachers' general knowledge about asthma (n = 334). (Percentage of correct answers.)
Teachers' answers
I. 2. 3. 4. 5. 6. 7. 8. 9.
Between 5 and lo'%,of all children suffer from asthma Asthma is frequently seen through several generations ("is hereditary") Asthma children often suffer from hayfever, too Asthma children often come from low social status homes Asthma children often have over-protective mothers Asthma may lead to low growth in children Asthma is affected by emotional factors Children may die from asthma In Denmark, about 5 to 10 children die every year due to asthma
Correct answer
Correct
Incorrect
Don't know
Correct Correct Correct Incorrect Incorrect Correct Correct Correct Correct
I99 (60.1) 273 (82.2) 256 (77.6) 256 (77.1) 203 (61.7) 70 (21.2) 239 (72.0) 241 (72.8) 110 (32.9)
38 21 19 30 54 123 45 28 26
94 38 55 40 72 137 48 61 I98
Table 2. Teachers' knowledge about asthma and sports (n= 334). (Percentage of correct answers.)
Teachers' answers Correct answer
I . Swimming is a good sport for asthma children 2. Asthma children should be encouraged to take active part in sports 3. Teachers should ensure that necessary medicine is taken before physical exercise 4. Asthma medicine taken before exertion in connection with sports may often prevent an attack 5. Sports in rainy weather increases the risk of setting off an attack 6. Sports in cold windy weather increases the risk of setting off an attack 7. Wheezing after exertion is an asthma indicator 8. Children with a well-treated asthma generally show poorer performances in physically demanding sports
Correct
Incorrect
Don't know
Correct Correct Correct
190 (57. I ) 267 (80.4) 190 (57.1)
37 9 42
I06 56 101
Correct
I90 (57.1)
15
I28
74 (22.2)
122 93 83
137 I30 60 82
Incorrect Correct Correct Incorrect
1 I 1 (33.2)
188 (56.8) 88 (26.3)
164
Table 3. Teachers' knowledge about treatment of asthma children (n = 334). (Percentage of correct answers.)
Teachers' answers
I. 2. 3. 4. 5. 6. 7. 8. 9.
Antibiotics (penicillin, etc.) are applied in asthma treatment Ventolin"/Bricanylb are airway opening medicaments Ventolin/Bricanyl are immediately effective Becotide' and Lomudald are immediately effective against wheezing Becotide and Lomudal are effective against respiratory infections Ventolin/Bricanyl may lead to increased pulse (palpitation) Ventolin/Bricanyl may lead to shaky hands Ventolin/Bricanyl are effective against respiratory infections The following medicament must be taken regularly (also during attack-free times) Ventolin Becotide Lomudal Bricanyl 10. The following medicaments must be taken at attacks (wheezing) Antibiotics Lomudal Ventolin Becotide Bricanyl I I . Ventolin/Bricanyl are the best medicaments before physical exercise 12. Ventolin/Bricanyl in urine leads to disqualification of athletes (doping-tests)e
Correct answer
Correct
Incorrect
Don't know
Incorrect Correct Correct Incorrect Incorrect Correct Correct Incorrect
188 (56.5) 188 (56.3) 160 (48.2) 18 (5.1) 28 (8.4) 72 (21.6) 57 (17.1) 44(13.3)
18 0 6 41 32 16 43
I27 I46 166 272 272 252 26 1 244
Incorrect Correct Correct Incorrect
19 (5.7) 28 (8.4) 33 (9.9) 17(5.1)
53 9 8 41
262 295 29 I 276
Incorrect Incorrect Correct Incorrect Correct Correct Correct
63 (19.0) 12 (3.6) 67 (20.1) 9 (2.7) 55 (16.6) 56 (16.8) 16 (4.8)
3 24 5 20 7 9 33
265 296 26 I 30 I 270 269 283
10
a Salbutamol; terbutaline; beclometasone dipropionate; sodium chromoglycate; salbutamol and terbutaline in urine means disqualification of athletes. This is not the case for asthma patients in inhalation treatment, provided sports festival medical officers have been notified about this before contest.
4I5
Schoolreachers’ knowledge about asthma
ACTA PEDIATR 81 (1992)
Table 4. Teachers’ knowledge about asthma and school attendance (n =334). (Percentage of correct answers.)
Teachers’ answers Correct answer I . An asthma child’s absence is a good indicator of the severity of the disease 2. Having attacks during school hours make children more afraid of further attacks 3. Asthma children have the same 1Q level as other children
Correct
Incorrect
Don’t know
Correct Correct
89 (27.5) 258 (77.7)
136 31
99 43
Correct
322 (97.0)
2
9
Table 5 . Teachers’ knowledge, experiences, and attitudes about asthma and treatment (n = 334). (Percentage of correct answers.)
Teachers’ answers ~
I. 2. 3. 4. 5. 6. 7. 8. 9. 10. I I. 12.
Do you think you know enough about asthma in children? Did you ever receive instruction about asthma? Did you ever notice that asthma children in any way differ from other children? Would you permit an asthma child to keep his medicine on him during school hours? Would you or have you instructed/advised a child in the use of his inhalation medicine (asthma spray)? Have you yourself got an asthma child? Do any of your close relatives suffer from asthma? Do or did you ever suffer from asthma yourself? Do you or did you ever have an asthma child in your classes? Have you ever had contact with parents due to children’s asthma? Is there a school nurse permanently or partially attached to your school? Is there a school doctor permanently or partially attached to your school?
Table 4 shows the teachers’ knowledge about asthma and school attendance. No significant correlation was found between previous instruction and number of correct answers. Table 5 shows teachers’ experience with and attitudes to asthma among schoolchildren. Only approximately 6% thought they knew enough about asthma, a figure which corresponded to the number of teachers who had received proper instruction. Twenty-one percent had supervised or intended to supervise children in the use of inhalers. Among those who had been instructed, significantly more were willing to d o this ( p
