Comics in Pediatric Patient Education - Comics & Medicine 2014

Comics in Pediatric Patient Education - Comics & Medicine 2014
Comics & Medicine 2014 Conference, Johns Hopkins University Alex Thomas, MD and Gary Ashwal, MA Comics in Pediatric Patient Education Superheroes, Monstrous Villains & Helpful Dinosaurs!
Booster Shot Comics is an independent company. The study is funded by a grant from Friends of U.Wisconsin Hospital and Clinics Disclosures Gary to unmasked font http://www.friendsofuwhc.orghttp://boostershotcomics.com
Gary Ashwal, MA Alex Thomas, MD
Background • Asthma is the third-ranking cause of hospitalization children • 36,000 children miss school every day due to asthma • The estimated cost in the U.S. of treating asthma in those younger than 18 years of age is $3.2 billion per year. Portnoy J, Jennings D. Utilization patterns in an asthma intervention. Ann Allergy Asthma Immunol. 2006;97(Suppl 1):S25-S30. CDC Vital Signs, May 2011. #IggyaDay
What can contribute to an asthma exacerbation requiring hospitalization? 1. Inherent severity of underlying disease 2. Problems with medication use 3. Exposure to environmental factors 4. Deficits in education regarding asthma diagnosis and management EPR-3. Expert panel report 3: guidelines for the diagnosis and management of asthma (EPR-3 2007). NIH Publication Number 08-5846. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2007.
Medication Adherence • Rescue inhalers bring immediate relief to asthma symptoms only offer temporary relief (2 hours) • More long lasting improvement and prevention of symptoms come with Controllers (must be taken daily) • Controller use in children with persistent asthma is low Finkelstein JA, Lozano P. Underuse of controller medications among medicaid-insured children with asthma. Arch Pedatr Adolesc Med. 2002; 156: 562-7 Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P et al. Use of inhaled anti-inflammatory medication in children with asthma in managed care settings. Arch Pedatr Adolesc Med. 2001; 155 (4): 501-7
Education is Key • Asthma education to promote self-management in children has been shown to improve lung function, asthma symptoms, reduce health care utilization and school absenteeism • According to guidelines, asthma education programs should be delivered to children during or following discharge from the ED or the hospital Finkelstein JA, Lozano P. Underuse of controller medications among medicaid-insured children with asthma. Arch Pedatr Adolesc Med. 2002; 156: 562-7 EPR-3. Expert panel report 3: guidelines for the diagnosis and management of asthma (EPR-3 2007). NIH Publication Number 08-5846. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2007.
Kathleen Shanovich, NP • Kathleen Shanovich, NP: education specialist for inpatient asthma consults • When not available, education is provided by floor nurse coordinating discharge, RT • But primary care clinics often do not have the time/staffing for individualized education Asthma Education
When an education specialist is not available • Greater reliance on the available educational materials – Inconsistent in quality – Inconsistent in how it is presented to kids • When one-on-one teaching is not available- with appropriate content, children can be challenged to play a more active role in the learning process
Create appropriate content to teach kids: 1. Difference between medications 2. Mechanisms of action for each medication Objective 10
Rescue Bronchodilator Proventil Albuterol Controller Corticosteroid Qvar Beclomethasone
Rescue Bronchodilator Pro Air Controller Corticosteroid Flovent
Rescue Bronchodilator Ventolin Controller Corticosteroid Budesonide Other blue one?
Approach • Kids can retain a great depth of knowledge in topics that interest them 15 http://www.pokemon.com/
Approach • By anthropomorphizing medications into characters with personalities and physical traits directly related to their mechanism of action, understanding can be much more intuitive 16http://cars.disney.com/ Lightning McQueen Mater
Controller Inhaled Corticosteroid © 1993, 1997, and 2009 by Alex Thomas; © 2013 Booster Shot Comics 17 Bronchodilator Albuterol Anthropomorphized Medications
18 Sequential Art Pathophysiology
19 Sequential Art Bronchodilator – Mechanism Of Action
20 Sequential Art Corticosteroid – Mechanism Of Action
21 Story-driven Patient Education Social Learning Theory – Modeling
Same messages. Multiple formats. 23 Comic Video Trading Cards
Focus Group Testing • 30 kids • 2 clinics (1 suburban, 1 urban) • Used feedback to make adjustments to characters, visuals, text – Comparison of normal to asthma airway – Indications of time • Ideal age is 8-11yrs – Age 6-7 enjoyed visuals – Age 5 and under could not understand
Madison Asthma Camp • Approximately 50 children (ages 8-13) – Higher risk group (identified by school nurses in the Dane count school districts) – Predominantly minority population • All day camp at UW School of Medicine • Goal to educate and empower children with asthma and allergies • Volunteers- Nurses, Nurse Practitioners, Allergists, Allergy Fellows, Respiratory Therapists, Pharmacists, Pharmacy Students, Parents 25
Asthma Camp Trials • Asthma Camp 2011 – Comic Book • Asthma Camp 2012 – Comic Book, Trading Cards, Small Groups • Asthma Camp 2013 – Comic Book, Trading Cards, Video, Small Groups • Asthma Camp 2014 – Comic Book, Trading Cards, Video, Posters, Games – Integration into entire camp curriculum
Comic Books
Comic Posters
Comic Posters as Teaching Tools
Educational Video
Games
Trading Cards
Pre-Test Post-Test 2013 Asthma Camp Qualitative Evaluation 33
2014 Asthma Camp Evaluation • Updated quantitative survey instrument for pre- and post-test based on the educational information in the Iggy and The Inhalers materials – Pre Test n=22 – Post Test n=33 Asthma Knowledge Test Version 5 April 2014 TESTYOURASTHMAKNOWLEDGE! (Pre-Test) Checkoneanswer for eachquestion. 1. Which one of these does NOT happen to an asthma airway? 1 The muscle bands around the airways tighten 2 The airways become swollen/inflammation happens 3 Mucus plugs the airways 4 The airways and lungs collapse 2. Which one of these is NOT one of the Asthma Rules of Two? 1 You have asthma symptoms more than 2 days a week 2 You use your rescue inhaler more than 2 days a week 3 You wake up with asthma more than 2 nights a month 4 You have more than 2 medicines for your asthma 3. Which of the following can make asthma worse/trigger your asthma? 1 Allergies, like pets, pollen, molds 2 Exercise 3 Tobacco smoke 4 All of these 4. Which one of these is FALSE about your asthma controller medicine: 1 Helps with the swelling and inflammation in the airways 2 Is also called a rescue medicine 3 It takes time to fix things, but is long lasting 4 You need to use it every day 5. Which one of these in NOT a symptom of asthma? 1 Cough 2 Ear ache 3 Wheeze 4 Short of breath 6. Your asthma bronchodilator medicine works fast (5-15 minutes) to make you feel better. 1 True 0 False
2014 Asthma Camp Evaluation 1. Which one of these does NOT happen to an asthma airway? 1 The muscle bands around the airways tighten 2 The airways become swollen/inflammation happens 3 Mucus plugs the airways 4 The airways and lungs collapse 50% 55% 60% 65% 70% 75% 80% 85% 90% PreTest Post Test Question 1 (% Correct) PreTest Post Test 77% 85% n=22 n=33
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% PreTest Post Test Question 2 (% Correct) PreTest Post Test 2014 Asthma Camp Evaluation 2. Which one of these is NOT one of the Asthma Rules of Two? 1 You have asthma symptoms more than 2 days a week 2 You use your rescue inhaler more than 2 days a week 3 You wake up with asthma more than 2 nights a month 4 You have more than 2 medicines for your asthma 68% 56% n=22 n=33
50% 55% 60% 65% 70% 75% 80% 85% 90% PreTest Post Test Question 3 (% Correct) PreTest Post Test 2014 Asthma Camp Evaluation 3. Which of the following can make asthma worse/trigger your asthma? 1 Allergies, like pets, pollen, molds 2 Exercise 3 Tobacco smoke 4 All of these 68% 79% n=22 n=33
0% 10% 20% 30% 40% 50% 60% 70% 80% PreTest Post Test Question 4 (% Correct) PreTest Post Test 2014 Asthma Camp Evaluation 4. Which one of these is FALSE about your asthma controller medicine: 1 Helps with the swelling and inflammation in the airways 2 Is also called a rescue medicine 3 It takes time to fix things, but is long lasting 4 You need to use it every day 18% 68% n=22 n=33
50% 55% 60% 65% 70% 75% 80% 85% 90% 95% PreTest Post Test Question 5 (% Correct) PreTest Post Test 2014 Asthma Camp Evaluation 5. Which one of these in NOT a symptom of asthma? 1 Cough 2 Ear ache 3 Wheeze 4 Short of breath 82% 91% n=22 n=33
50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% PreTest Post Test Question 6 (% Correct) PreTest Post Test 2014 Asthma Camp Evaluation 6. Your asthma bronchodilator medicine works fast (5-15 minutes) to make you feel better. 1 True 0 False 86% 97% n=22 n=33
Madison Asthma Camp (50 campers/year) School Health Fairs (~200 students per fair) 20 South Park Pediatrics (100 patients/month) UW Health Allergy Clinics (160 patients/month) American Family Children’s Hospital (10 patients/month) Implementation
A Big Thanks to the Kids!
Thank you! 46 Alex Thomas, MD alex@boostershotcomics.com Gary Ashwal gary@boostershotcomics.com BoosterShotComics.com /boostershotcomics /boostershotcmx /boostershotcomics

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