Journal of Urban Health

, Volume 77, Issue 2, pp 280–297 | Cite as

A randomized field trial of acindes: A child-centered training model for children with chronic illnesses (asthma and epilepsy)

  • J. A. Tieffenberg
  • E. I. Wood
  • A. Alonso
  • M. S. Tossutti
  • M. F. Vicente
Original Articles: Various Topics



A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8–10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls=.69 for epilepsy and .56 for asthma, with σ2= .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain=.62 (σ2=.0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P=.036 andP=.026). Visits to physicians showed a significant decrease for those with asthma (P=.048), and emergency visits decreased for those with epilepsy (P=.046).

An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P<.01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winterP=.006, and springP=.029; for the group with epilepsy,P=.011).


The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.

Key Words

Asthma Children Chronic illnesses Diabetes Self-help Training 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kemp JP. Comprehensive asthma management: guidelines for clinicians.J Asthma. 1998;35(8):601–620.PubMedGoogle Scholar
  2. 2.
    Green M, Haggerty RJ.Ambulatory Pediatrics II. Philadelphia: W. B. Saunders Co. 1977.Google Scholar
  3. 3.
    Hughes DM, Mc Leod M, Jones B, Golbloom R. Controlled trial of a home and ambulatory program for asthmatic children.Pediatrics. 1991;87:54–61.PubMedGoogle Scholar
  4. 4.
    American Lung Association.The Many Faces of Asthma. American Lung Association Annual Report. 1988, p. 9.Google Scholar
  5. 5.
    Mao Y, Semenciw R, Morrison H, et al. Increased rates of illness and death from asthma in Canada.Can Med Assoc J. 1987;137:620–624.Google Scholar
  6. 6.
    Wolfish MG, McLean J. Chronic illness in adolescents.Pediatr Clin North Am. 1974; 21(4):1043–1045.PubMedGoogle Scholar
  7. 7.
    Fireman P, Friday GA, Gira C, Vierthaler WA, Michaels L. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting.Pediatrics. 1981;68:341–348.PubMedGoogle Scholar
  8. 8.
    National Asthma Education and Prevention Program.Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health; 1995. Publication 96-3659 A.Google Scholar
  9. 9.
    National Asthma Education Program.Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health; 1991. Publication, 91-3042 A.Google Scholar
  10. 10.
    Sly RM. changing asthma mortality and sales of inhaled bronchodilators and antiasthmatic drugs.Ann Allergy. 1994;73:439–443.PubMedGoogle Scholar
  11. 11.
    Workshop proceedings on self-management of childhood asthma.J Allergy Clin Immunol. 1983;72:S519–S626.Google Scholar
  12. 12.
    Taggart VJ, Zuckerman A, Lucas S, Acty-Lindsey A, Bellanti J. Adapting a self-management education program for asthma for use in an outpatient clinic.Ann Allergy. 1987; 58(3):173–178.PubMedGoogle Scholar
  13. 13.
    Parker S, Wolfe J, eds. Asthma self-management: a second generation of research programs.Health Educ Q. 1987;14(3).Google Scholar
  14. 14.
    Gross A, Magalnick L, Richardson P. Self-management training with families of insulin-dependent diabetic children: a controlled long-term investigation.Child Fam Behav Ther. 1985;7(1).Google Scholar
  15. 15.
    Childhood Asthma Management Program Research Group. Recruitment of participants in the Childhood Asthma Management Program (CAMP). I. Description of methods.J Asthma. 1999;36(3):217–237.Google Scholar
  16. 16.
    Thapar A. Educating asthmatic patients in primary care: a pilot study of small groups education.Fam Pract. 1994;11(1):39–43.PubMedGoogle Scholar
  17. 17.
    Stein R, Perrin E, Pless B, et al. Severity of illness: concepts and measurements.Lancet. 1987;2:1506–1509.PubMedGoogle Scholar
  18. 18.
    Piaget J.The Equilibration of Cognitive Structures. The Central Problem of Intellectual Development, Chicago, IL: University of Chicago Press; 1975, 1985.Google Scholar
  19. 19.
    Piaget J.Les Relations Entre l'Affectivite et l'Intelligence dans le Développement Mental de l'Enfant. Paris: Centre de Documentation Universitaire. Published in part in: Piaget J.Intelligence and Affectivity: Their Relation During Child Development, Palo Alto, CA: Annual Reviews, 1954–1981.Google Scholar
  20. 20.
    Piaget J.The Moral Judgement of the Child, London: Free Press; 1932, 1965.Google Scholar
  21. 21.
    Rotter JIB.Social Learning and Clinical Psychology. Englewood Cliffs, NJ: Prentice-Hall; 1954.Google Scholar
  22. 22.
    Wallston K, Kaplan C, Maides S, Wallston B. Development and validation of the health locus of control (HLC) scale.J Clin Psychol. 1976;44:580–585.Google Scholar
  23. 23.
    Wallston K, Wallston B.Health Locus of control Scales. Research with the Locus of Control construct: 1981, p. 11.Google Scholar
  24. 24.
    Bandura A. Psychological aspects of prognostic judgements. In: Evans RW, Baskin DS, Yatsu FM, eds.Prognosis in Neurological Disease. New York, NY: Oxford University Press; 1990.Google Scholar
  25. 25.
    Parcel G, Nader P. Evaluation of a pilot school health education program for asthmatic children.J School Health. October 1977;453–456.Google Scholar
  26. 26.
    Lewis CH, Rachelefsky G, Lewis MA, De La Sota A, Kaplan M. A randomized trial of ACT for kids.Pediatrics. 1984;74(4):478–486.PubMedGoogle Scholar
  27. 27.
    DeVries R, Kohlberg L.Constructivist Early Education: Overview and Comparison with Other Programs. Washington, DC: National Association for the Education of Young Children; 1990.Google Scholar
  28. 28.
    SPSS/PC+Advanced Statistics, Cluster Analysis—Statistics Guide. 1986:B71.Google Scholar
  29. 29.
    Everitt BS.Cluster Analysis. London, England: Heineman; 1980.Google Scholar
  30. 30.
    Romesburg HC.Cluster Analysis for Researchers. Belmont, CA: Lifetime Learning Publishers; 1984.Google Scholar
  31. 31.
    Easlon J, Hillman B, Shapiro G, et al., Management of asthma.Pediatrics. 1981;68: 874–879.Google Scholar
  32. 32.
    Richards W, and the AAP Committee of the Section of Allergy and Immunology. Principles of diagnosis and management of asthma for the practicing physician. Consensus statement report presented at: AAP Annual Meeting; October 1989.Google Scholar
  33. 33.
    Harris D.El Test de Goodenough: Revisión, Amplicación y Actualización, Buenos Aires, Argentina: Paidos; 1981:384.Google Scholar
  34. 34.
    Parcel CS, Meyer MP. Development of an instrument to measure children's health locus of control.Health Educ Monogr. 1978;6(2):149–159.PubMedGoogle Scholar
  35. 35.
    Wood I, Carlini MT, Tieffenberg JA. Monitoring changes in health-related attitudes and beliefs of children with chronic disorders: results using a children's Health Locus of Control Scale. In: Latin American Society for Pediatric Research Proceedings of the 16th Annual Meeting; November 1988. Abstract 62.Google Scholar
  36. 36.
    O'Brien R, Bush P, Parcel C. Stability in a measure of children's Health Locus of Control.J School Health. 1989;59(4):161–164.PubMedGoogle Scholar
  37. 37.
    Duncan D. A significance test for differences between ranked treatments in an analysis of variance.Va J Sci. 1951;2:171–189.Google Scholar
  38. 38.
    Mann HB, Whitney DR. On a test of whether one or two random variables is statistically larger than the other.Ann Math Stat. 1947;18:50–60.Google Scholar
  39. 39.
    Colditz C, Miller J, Mosteller F. Measuring gain in the evaluation of medical technology: the probability of a better outcome.Int J Technol Assess Health Care. 1988;4:637–642.PubMedGoogle Scholar
  40. 40.
    Parcel G, Gilman S, Nader P, Bunce H. A comparison of absentee rates of elementary schoolchildren with asthma and nonasthmatic schoolmates.Pediatrics. 1979;64(6):878–881.PubMedGoogle Scholar
  41. 41.
    Krutzsch C, Bellicha T, Parker S. Making childhood asthma management education happen in the community: translating health behavioral research into local programs.Health Educ Q. 1987;14(3):357–373.PubMedGoogle Scholar
  42. 42.
    DeVries R, Kamii C.Why Group Games? A Piagetian Perspective. Urbana, IL: Eric Publications Office; 1975.Google Scholar
  43. 43.
    Van Der Kooij R, Hellendoorm J, eds.Play—Play Therapy—Play Research: International Symposium, Amsterdam, the Netherlands, September 1985.Google Scholar
  44. 44.
    Bransky RE. A study of absence from school.Med Officer. 1951;86:223–237.Google Scholar
  45. 45.
    Perrin E, Shapiro E. Health locus of control beliefs of healthy children, children with a chronic physical illness, and their mothers.Pediatrics. 1985;107:627–633.Google Scholar
  46. 46.
    Hui Ch. Locus of Control: a review of cross-cultural research.Int J Intercultural Relations. 1982;6:301–323(a).Google Scholar
  47. 47.
    Hui Ch, Triandis HC. Multistrategy approach to cross-cultural research: the case of Locus of Control.J Cross Cultural Psychol. 1983;14(1):65–83.Google Scholar

Copyright information

© The New York Academy of Medicine 2000

Authors and Affiliations

  • J. A. Tieffenberg
    • 1
  • E. I. Wood
    • 1
  • A. Alonso
    • 1
  • M. S. Tossutti
    • 1
  • M. F. Vicente
    • 1
  1. 1.Research DivisionSelf-Help Training Project of ACINDES, Association for Health Research and DevelopmentBuenos AiresArgentina

Personalised recommendations