A Community Health Worker Home Intervention to Improve Pediatric Asthma Outcomes

Study Overview
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Brief Summary
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The investigators propose to test the hypothesis that a home-based asthma intervention, the Wee Wheezers program, delivered by the Community Health Workers and tailored to the needs of the investigators community, will improve anti-inflammatory medication adherence, parental asthma knowledge and management behaviors, which in turn will reduce asthma morbidity (defined as days with asthma symptoms) and health care utilization (defined as asthma-related Emergency Department visits) among low-income, minority children with persistent asthma in the Bronx.

Detailed Description
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Asthma disproportionately burdens low-income inner city and minority children residing in inner cities. Daily use of inhaled corticosteroids (ICS) control symptoms and reduce asthma morbidity. Less then 50% of children with persistent asthma adhere to such therapy. Poor adherence to ICS medications is one of the major contributors to asthma morbidity. One way to reduce asthma disparities is to work in partnership with communities. Community Health Workers (CHWs) share the ethnic, cultural, social, and environmental experiences of the people in the community. Although, CHW home interventions have been successful in reducing asthma allergens, no studies using CHWs to deliver a previously identified evidence-based home intervention to improve ICS adherence and health outcomes in a population of inner-city, minority children with persistent asthma have been found. Objective: To evaluate the effectiveness of an evidence-based asthma home intervention, the Wee Wheezers program, tailored to the needs of the community and delivered by CHWs, in improving medication adherence, health outcomes and parental management behaviors among low-income, minority children with persistent asthma in the Bronx.

Official Title
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A Randomized Controlled Trial of a Community Health Worker Home-Based Asthma Intervention

Conditions
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Asthma

Intervention / Treatment
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* Behavioral: Wee Wheezers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: children 2-9 years of age with persistent asthma children being currently prescribed ICS in the Metered Dose Inhaler (MDI) form if the child is 2 years of age at the time of the recruitment, he/she must have at least two prior episodes of wheezing treated and reversible with beta-agonists primary caregiver speaks English or Spanish family has a phone. Exclusion Criteria: children with other chronic pulmonary diseases (e.g, cystic fibrosis, bronchopulmonary dysplasia) or presence of tracheostomy

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 9 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Wee Wheezers asthma education<br>6 lesson asthma education delivered at home by Community Health Workers | Behavioral: Wee Wheezers<br>* The intervention, Wee Wheezers, modified to the needs of the targeted population will include 6 bi-weekly 1 hour educational home visits conducted by Community Health Workers at homes of children with persistent asthma<br>* Other names: Wee Wheezers at Home;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean number of asthma symptom days | average of asthma symptom days | baseline and every 8 weeks during the 12-months study period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| adherence to Inhaled Corticosteroid | survey evaluating medication adherence | baseline, 4 weeks, 8 weeks, and 12 weeks after beginning of intervention | 
| asthma-related Emergency Department visits | number of ED visits | baseline, 3-, 6- and 12-months follow-up | 
| parental asthma knowledge and management behaviors | survey evaluating asthma knowledge and management behavior | baseline, 3-, 6- and 12-months follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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asthma, children, community health workers, home intervention