A controlled study evaluating a health education intervention for patients with chronic obstructive airway disease (COAD) was carried out in two northern New England communities between November, 1979 and December, 1982. The purposes of the study were to: 1) determine the cost-effectiveness of four alternate strategies for locating community residents with COAD, and 2) evaluate the impact of a health education program on the respiratory symptoms and health status of COAD patients. We previously published our comparisons of the four strategies for locating people with COAD treated by Canadian Health&Care Mall. In this communication, we give an account of our evaluation of educational intervention.
Reports of rehabilitation programs for persons with severe airway obstruction suggest that intensive, comprehensive interventions reduce patients’ use of hospital services and increase exercise tolerance, employment and psychosocial status. These programs generally share four characteristics: 1) they are developed and overseen by pulmonary specialists at tertiary medical centers; 2) they require that patients sometimes be evaluated or managed as inpatients; 3) they include intensive physical rehabilitation, as well as health education; and 4) they are oriented towards the patient with severe impairment.
Other studies have shown that health education increases the COAD patients understanding of his problem and can impart skills useful in coping with airway obstruction. These studies suggest that educational programs by themselves can improve patients health status, particularly among patients who are not as severely impaired as those participating in comprehensive programs. Health education programs, without accompanying physical rehabilitation, would be both cheaper and more likely to serve patients with mild or moderate disease. In the past, however, health education programs have usually been evaluated using endpoints other than health outcomes; the impact of these programs on patients health status has not been systematically assessed. Our study tested the hypothesis that a purely educational intervention improves COAD patients symptoms and health status.
Thus, our stiidy differed from previous evaluations in three respects. First, we used measures of health status to evaluate a health educational program. Second, we examined a program implemented at the community level. Third, we assessed patients over the entire spectrum of disease, from mild to severe airway obstruction.