Outcomes of a Home-Based Environmental Remediation for Urban Children with Asthma (original) (raw)
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American Journal of Public Health, 2009
Objectives. We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma. Methods. Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were randomly assigned into 2 groups (immediate and delayed intervention) in a crossover study. Each group participated in the active phase (intervention) and the inactive phase. Outcomes included asthma symptoms, albuterol use, emergency department visits, hospitalizations, and trigger reduction. Results. A total of 264 primarily Black (94%) children were enrolled. The mean number of emergency visits decreased by 30% and inpatient visits decreased by 53% (P < .001) after the intervention. Reductions were seen in pests, presence of carpets in bedrooms, and dust. Nighttime wheezing was significantly reduced after the intervention in both groups ...
Social Science & …, 2006
We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.
Journal of Asthma, 2009
Community health worker (CHW)-delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; (2) delivered by a CHW; (3) delivered to families with children with asthma; and (4) addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies. Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model identifying pathways for future investigation is presented.
Outcomes of an asthma program: Healthy Children, Healthy Homes
Pediatric nursing
To test the effects of the Healthy Children Healthy Homes program on community perception of susceptibility and severity of asthma, knowledge of common household asthma triggers, misconceptions about asthma, and reported behaviors to control asthma triggers. Quasi experimental study with pre-post survey conducted in English and Spanish. Catholic elementary school community in northern Miami, Florida. SELECTION AND SAMPLE: Convenience sample of 15 Asthma Amigo participants, and pre-post survey sample of 100 parents, teachers, and school staff. Program consists of two 90-minute educational sessions with Asthma Amigos, 8-week diffusion of asthma information in the community, educational sessions with 276 school children (grades 1 to 8), and an asthma fair. Compared to pre-intervention, post-intervention data indicated significantly greater perceived asthma susceptibility and knowledge about common household triggers and fewer asthma misconceptions. Healthy Children Healthy Homes progra...
Journal of Exposure Analysis and Environmental Epidemiology, 2004
The effectiveness of community health workers (CHWs) assisting families in reducing exposure to indoor asthma triggers has not been studied. In all, 274 low-income asthmatic children were randomly assigned to high-or low-intensity groups. CHWs visited all homes to assess exposures, develop action plans and provide bedding encasements. The higher-intensity group also received cleaning equipment and five to nine visits over a year focusing on asthma trigger reduction. The asthma trigger composite score decreased from 1.56 to 1.19 (D ¼ À0.37, 95% CI 0.13, 0.61) in the higher-intensity group and from 1.63 to 1.43 in the low-intensity group (D ¼ À0.20, 95% CI 0.004, 0.4). The difference in this measure due to the intervention was significant at the P ¼ 0.096 level. The higher-intensity group also showed improvement during the intervention year in measurements of condensation, roaches, moisture, cleaning behavior, dust weight, dust mite antigen, and total antigens above a cut point, effects not demonstrated in the low-intensity group. CHWs are effective in reducing asthma trigger exposure in low-income children. Further research is needed to determine the effectiveness of specific interventions and structural improvements on asthma trigger exposure and health.
Examining Home Visits from Community Health Workers to Help Patients Manage Asthma Symptoms
2020
Background: A disproportionate burden of asthma is borne by racially and ethnically diverse groups with low income, disparities that are driven by social determinants of health. Little is known about the potential synergies between community health worker (CHW) home-visit services and planned, preventive asthma primary care visits (ie, enhanced clinical care). Objectives: Public Health-Seattle & King County, in partnership with local clinics, health plans, other asthma experts, and patients, reviewed existing asthma clinical guidelines for incorporation into community and clinical asthma health care interventions. We then assessed the effectiveness of a CHW home-visit protocol compared with usual care focused on lowincome and racially and ethnically diverse groups with asthma. This trial was nested in a feasibility study of a planned preventive asthma "enhanced clinical care" intervention among a nonrandomly selected group of "safety-net" clinics, where attempts were made to coordinate the CHW's work with that of the clinical teams. This trial is known as Guidelines to Practice (G2P). Conclusions: We demonstrated statistically significant improvements across 8 health outcomes among patients randomly assigned to receive CHW services vs usual care. However, 2 of the 3 primary outcome measures, ACT and AQLQ scores, failed to meet the published MCID in this hard-to-reach population. 63,64 Both care teams and CHWs reported that coordinating planned asthma care with the CHW's work was both feasible and acceptable. Limitations: The study had 9 main limitations: (1) The 4 enhanced clinical care intervention clinics were not chosen randomly. (2) The uptake of the clinic-based Planned Asthma Change Package by providers beyond the identified change team (ie, practice-wide spread) took longer