Intervention for Improving Asthma Care for Minority Children in Head Start
Condition: Asthma; Lung Diseases
MeSH terms: Asthma; Lung Diseases
Study type: Interventional

Summary: 
      This study will evaluate two interventions that are designed to reduce asthma morbidity and
      improve asthma care of children in Head Start in urban Baltimore.
    

Detailed description: 
      BACKGROUND:

      Asthma-related morbidity and mortality are disproportionately high among low-income African
      American children. The effects of asthma are particularly harsh in very young children and
      their families, resulting in high rates of emergency department care, hospitalization,
      decreased quality of life, and the risk of fatal asthma. Research suggests that the
      contributing factors to this high morbidity include under-use of asthma primary preventive
      care, sub-optimal medical management, and inappropriate asthma management behaviors. Despite
      the importance of early and regular asthma preventive care for children, this goal has proved
      elusive. Head Start programs offer an ideal venue for accessing high-risk, low-income
      preschool children and improving asthma morbidity. The study will test the hypothesis that
      removing barriers to preventive asthma care and facilitating communication between parents
      and primary care providers (PCP) are necessary prerequisites to optimally influence
      caregiver's asthma management practices. The study will remove barriers by the use of
      Breathmobile, a community-based service that is specifically designed to deliver asthma
      screening and special consultation directly to families and children in high-risk
      neighborhoods. In addition, the study will evaluate a caregiver/PCP communication
      intervention designed to facilitate communication between parents and PCPs about a child's
      asthma severity and recommended therapy.

      DESIGN NARRATIVE:

      This two times two modified factorial study design will compare the following in their
      effectiveness in reducing asthma morbidity and improving asthma management: a Breathmobile
      intervention combined with a Facilitated Asthma Communication intervention (FACI); a FACI
      alone; the Breathmobile intervention alone; or a control group. A total of 360 Head Start
      students ages 2 to 6 with symptomatic doctor-diagnosed asthma will be recruited. The primary
      study outcome measure will be the number of symptom-free days over a period of 12 months.
      Secondary outcomes include health care utilization (i.e., emergency department visits,
      hospitalizations, and primary care visits), asthma medications, parent asthma-related quality
      of life, parent asthma management practices, and cost-effectiveness. The study will test the
      hypothesis that a FACI combined with the Breathmobile intervention will be the most effective
      in improving parent and PCP management of the child's asthma and in reducing asthma
      morbidity.
    

Intervention name(s): Facilitated Asthma Communication Intervention (FACI); Breathmobile intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A caregiver/PCP communication intervention designed to facilitate communication between parents and PCPs about a child's asthma severity and recommended therapy.; A community-based service that is specifically designed to deliver asthma screening and special consultation directly to families and children in high-risk neighborhoods.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention