Proposed is a non-randomized, controlled, prospective trial to test the efficacy of a bilingual intervention to improve asthma care for low-income inner-city children enrolled in subsidized preschool childcare programs. Because of high rates of asthma prevalence, subsidized preschool childcare programs offer ideal settings to test innovative strategies to improve asthma care within communities at highest risk of morbidity. There are three intervention arms to this study. Surveillance - identifying the children that have diagnosed asthma and requiring written asthma action plans from their providers. Surveillance plus monitoring - adds a system to track parent compliance with the asthma action plan requirement. Surveillance plus monitoring plus education - adds individualized asthma education to promote adherence and a partnership between parent and doctor. This design aims to test whether a monthly monitoring system increases the proportion of parents who obtain written asthma action plans compared with parents in the surveillance only arm. It also aims to compare parents who receive individualized asthma education with parents in the surveillance and monitoring arm as to the proportion who are prescribed controller medications, who regularly administer controller medications to the child, and who report persistent asthma symptoms, Emergency Department visits and hospitalization for asthma. To test these aims, the three arms will be implemented in subsidized childcare programs in East Harlem, the Lower East Side and the South Bronx - 3 geographically separate New York City communities with high rates of asthma prevalence. A total of 191 parents of asthmatic children aged 2.8-4 years old will be recruited into the study. Interviews will be conducted at baseline, 4, 8 and 12-month follow-up. Because of the non-randomized design, additional intervention components will be phased in at program sites to verify that effects are due to intervention rather than community differences. Baseline measures of the three groups will be compared and multivariate models will be used to address key research hypotheses in this study. This study will provide data on efforts at the institutional and individual levels that can be directed to reducing asthma morbidity in populations most heavily impacted by the disease.
| Purmort, Jessica; Coady, Micaela H; Bucciarelli, Angela et al. (2008) Asthma education in a subsidized preschool setting. J Health Care Poor Underserved 19:1241-7 |
