A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes

Abstract

Objective

The objective of this study was to evaluate the effects of using Community Health Workers (CHWs) to deliver the home-based Wee Wheezers asthma education program on asthma symptoms among children with persistent asthma.

Methods

In this randomized controlled trial of 151 children aged 2–9 years with persistent asthma, we assigned 75 to the intervention and 76 to the control. The primary outcome was caregiver-reported asthma symptom days. Secondary outcomes included asthma-related healthcare utilization, caregivers’ asthma knowledge, illness perception and management behaviors, MDI-spacer administration technique, and home environmental triggers. Outcomes were collected at baseline, 3, 6, 9 and 12 months. A repeated measurements analytic approach with generalized estimating equations was used. To account for missing data, multiple imputation methods were employed.

Results

At 3 and 6 months, improvement in symptom days was not significantly different between groups. However, at 9 and 12 months, the reduction in asthma symptom days was 2.15 and 2.31 days more respectively for those in the intervention group compared to the control. Improvements in MDI-spacer technique, knowledge and attitudes were significant throughout follow-up. Improvement in habits regarding MDI use was significant at 3 and 6 months, and asthma routines were improved at 3 months. However, there was no change in asthma-related healthcare utilization or home environmental triggers.

Conclusion

Using CHWs to deliver a home-based asthma education program to caregivers of children with persistent asthma led to improvements in symptom days and several secondary outcomes. Expanding the use of CHWs to provide home-based interventions can help reduce disparities in children’s health outcomes.

Keywords:

• Children
• community health workers
• home intervention
• Wee Wheezers
• education

Acknowledgements

We thank Philip O. Ozuah, MD, PhD (Montefiore Medicine) for his guidance and mentorship on this project; Agnieszka Cain, MD, MBA (Mount Sinai Morningside and Mount Sinai West Hospitals) for help with literature search; Maria Ivanna Avalos Palacios, BA (Children’s Hospital at Montefiore), our community health worker, for intervention delivery; and Ellen J. Silver, PhD (Albert Einstein College of Medicine) for preliminary data analyses. We are grateful to all the children and their caregivers for their participation in the study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

The study was funded by the American Lung Association Clinical Patient Care Grant (CG-1,20 837-N, Reznik – PI), the New York Community Trust Foundation (Reznik – PI), Stony Wold-Herbert Fund (Reznik – PI), Monaghan Medical Corporation (Reznik – PI) and Department of Pediatrics, the Children’s Hospital at Montefiore. The funding sponsors had no role in study design, collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication.