RVA Breathes: A Richmond City Collaboration to Reduce Pediatric Asthma Disparities
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The goal of this study is to evaluate a sustainable, community-engaged program to reduce
      asthma disparities among 5 to 11-year-old children in Richmond, Virginia. Richmond, an urban
      center, has been named the Asthma Capital, or "most challenging place to live in the U.S.
      with asthma," by the Asthma and Allergy Foundation three times in the last 5 years. To date,
      however, the city has no comprehensive, community-engaged asthma care program for those
      children at highest risk for poor asthma outcomes. To address this disparity, the study team
      engaged with community partners and completed a mixed-methods needs assessment to enhance
      understanding of the barriers and supports to asthma care for children and their families
      living in Richmond. Several key priority areas emerged: peer support, advocacy, treating the
      home as a system, increased school nurse education, and coordination with schools and
      providers. Working together, the community-engaged team translated needs assessment findings
      to RVA Breathes, a program coordinating asthma care across 4 sectors: family, home,
      community, and medical care.
    

Detailed description: 
      RVA Breathes includes family-based asthma self-management education (delivered by Community
      Health Workers [CHWs] with the Institute for Public Health Innovation), home environmental
      remediation (with Richmond City Health Department's Healthy Homes Initiative), and a school
      nurse component (with elementary schools in the Richmond City Public School System). These
      interventions capitalize among existing resources and relationships with stakeholders in
      Richmond, each of which is committed to RVA Breathes. Two hundred-fifty children with asthma
      and their caregivers participated in a randomized clinical trial of RVA Breathes. After
      completing a baseline assessment, families were randomized to one of three conditions: 1)
      asthma education + home remediation + school intervention, 2) asthma education + home
      remediation and 3) comparator condition (Enhanced Standard of Care, E-SOC). Families
      participated in the program for 9 months and completed follow-up assessments (post-treatment
      and 3-, 6-, and 9-month) to measure changes in healthcare utilization and the impact of the
      program on child asthma outcomes. Conditions were compared on the primary outcome of
      asthma-related healthcare utilization, including asthma specific ED visits and hospital
      admissions. Secondary outcomes included need for controller medication use, asthma control,
      asthma symptoms, asthma action plans, and quality of life. We will also evaluate the
      sustainability of RVA Breathes after 9 months (without active intervention), including a
      review of qualitative data from participants and stakeholders in the program. Findings from
      this trial will allow for dissemination and implementation of RVA Breathes as a sustainable
      program in the Richmond are.
    

Intervention name(s): School; Asthma education; Home environmental remediation; Informational mail
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): CHWs will ensure that families submit required health paperwork (e.g., asthma action plan, medication release form) and confirm with school nurses that children have the appropriate medications. School nurses will be given a standardized protocol to follow with clear guidelines for caring for students with asthma. The CHW assigned to the family will work with the school nurse to ensure that communication with the medical provider is occurring.; CHWs will deliver evidence-based asthma education to parents and children. Content is drawn from existing asthma management programs, and adapted for families in Richmond. Between sessions, CHWs will call parents at least monthly to check in and assess family asthma management, including healthcare utilization since the last contact.; Healthy Homes will complete home-based environmental assessments using evidence-based protocols. Healthy Homes will provide real-time education and share information about their findings and recommendations for action. Families are provided with low-cost intervention materials (e.g., filters, pillow covers), as well as behavioral modifications to aid in the reduction of asthma triggers in the home.; Family will be mailed publicly available asthma information every 3 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention