Al-Sheyab is hoping peer pressure will encourage
Jordanian youths to seek treatment for their
asthma and avoid triggers, such as smoking.
Photo by Nihaya Al-Sheyab

Asthma is an unwelcome familiarity for over two million Australians. At the height of an asthma attack, the muscles around the airways tighten and swell, and mucus begins to build up in the throat, obstructing any attempts to breathe. That claustrophobic feeling of helplessness is frightening to imagine, even for a moment. “Unless there is immediate action people can lose their lives. It’s a really serious problem,” says PhD candidate in the Faculty of Nursing Midwifery and Health Nihaya Al-Sheyab.

Frightening as this is, it’s disturbing that such an attack could be prevented or easily managed with the right training, but fatal without it. It’s for this reason that Al-Sheyab has begun a study into peer-led asthma education back in her home country of Jordan, a nation where asthma cases have tripled since 1994, and which has almost no awareness of the disease, its causes and its cures.

“There are kids and adolescents with asthma attacks and wheezing, but they’ve never been diagnosed by a professional doctor or health member. They just come to the hospital when they feel the asthma but they’ve never used any preventative medications.” Al-Sheyab explains. “I’d really like to highlight this problem and do something about it.”

Following the successful completion of a pilot study, Al-Sheyab began a full program in 2006 using 261 students from four Jordanian schools – two of which served as a control group. “The aim of my study was to trial the Triple A program – the adolescent asthma action program – in Jordanian schools,” she says.

According to Al-Sheyab the program works in a peer-led manner “to see how peer pressure can affect the transfer of messages to the school community.” She goes on to explain how it also focuses on smoking as the prime cause of asthma attacks. “Cigarette smoking is one of the most important and common triggers, especially in adolescents.

“In Jordan about 50 per cent of parents and family members are smokers, so students are exposed to passive smoking,” she says, noting that this is a conservative figure. And passive smoking isn’t the only concern. According to Al-Sheyab, the absence of a legal age-limit in Jordan means that children as young as 10-years-old can buy cigarettes.

The program's leader, Nihaya Al-Sheyab.
Photo by Joanne Saad

Rather than simply teaching each student about asthma, a group of Year 11 students are chosen as Asthma Peer Leaders (APLs). Al-Sheyab explains how each APL is trained to make them familiar with asthma, asthma triggers and asthma medication.

“They learn to empower themselves by learning how to say no to smoking,” she adds. The year 11 students then teach year 10 students, who transform what they’ve learned into poetry, improvisation and drama to teach those in lower grades.

“The students just loved it,” enthuses Al- Sheyab. According to her findings, students exposed to the Triple A program showed an improvement in their quality of life and awareness of the disease. “We measured the emotional, physical and symptoms- based quality of life before, and after, three months...It was surprising how it has improved in the intervention school, but not in the control group,” she adds.

While Al-Sheyab plans to go back to Jordan to do more work on asthma education, she now sees other potential applications of this research and hopes to expand her study. “My long-term plan is to adapt this peer- led education and address the health-risk behaviours that most concern adolescents in Jordan, and obesity is certainly one of these,” she concludes. For now, however, her concerns remain with asthma in Jordan’s schools and, of course, a thesis to finish.