The goal of this U34 application, submitted in response to RFA-HL-15-028: Creating Asthma Empowerment Collaborations to Reduce Childhood Asthma Disparities, is to conduct a community-based needs assessment to inform the development of a randomized clinical trial to decrease asthma morbidity and healthcare utilization among urban children with asthma (5-17 years) in Richmond City. Richmond, an urban center, has been named by the Asthma and Allergy Foundation as the Asthma Capital (i.e., most challenging place to live in the United States with asthma) three times in the last fou years. We will partner with Engaging Richmond, an existing community-university partnership at VCU (NCATS UL1TR000058) in conducting our needs assessment and developing an Asthma Care Implementation Program (ACIP) for children. We will use a model of community engagement from the beginning of our planning year that involves community residents in every step of our needs assessment from recruitment to dissemination. The community needs assessment will include six elements: caregiver and youth advisory groups; monthly meetings with stakeholders; caregiver and child focus groups; community survey of caregivers of children with asthma; model synthesis; interviews with key informants. Goals of our formative mixed-methods needs assessment include: 1) identifying factors that promote or inhibit effective asthma management in urban families, 2) identifying specific community concerns related to the treatment of children with asthma, 3) engaging community stakeholders in identifying and prioritizing the needs of families of children with asthma, and 4) using feedback from our needs assessment to modify the proposed ACIP and develop a protocol to assess the ACIP. Stakeholders and key informants include representatives from the Richmond City Health District, an area asthma coalition, policy makers, individuals in community-based organizations, caregivers of children with asthma, children with asthma, and asthma clinicians at area hospitals. Our proposed ACIP includes 3 evidence-based intervention components: 1) a community-based initiative that reduces home environmental exposures, 2) asthma self-management education delivered by community health workers, and 3) coordination with the child's asthma care provider to ensure appropriate evidence-based medical treatment. The integration of our ACIP is novel in that a case management committee (e.g., community health worker, pediatric nurse, psychologist) will ask caregivers directly about challenges they face in managing their child's asthma; these challenges may be embedded within the family's culture or within the family's community. We will use the results of our needs assessment to ensure that our interventions meet the needs of families in Richmond and address the highest priority items related to childhood asthma for these families. Through the innovative use of Engaging Richmond, we will be better able to consider the cultural context in which families live and the resources families in Richmond would need to succeed in the ACIP.
. Childhood asthma disparities persist among urban settings, including the City of Richmond. Children with asthma in Richmond are a high-risk group for increased rates of asthma morbidity and healthcare utilization. This study will use a community needs assessment to inform the development of a program of care for children with asthma that will be tested in a subsequent randomized clinical trial.