Improving Asthma Management among African-American Children via a Community Health Worker Model: Findings from a Chicago-Based Pilot Intervention

Abstract

Objectives. Asthma affects 25–30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods. Methods. Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Results. Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention. Conclusions. Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model’s generalizability.

• African American
• community health workers
• disease management
• pediatric asthma

Acknowledgments

This work could not have been done without the dedication and time of several staff members of the Sinai Urban Health Institute and Sinai Children’s Hospital, especially Gloria Seals, Intervention Coordinator, Sinai Children’s Hospital, and Dr. Dennis Vickers, Chairman, Sinai Department of Pediatrics. We are also grateful to Dr. Eric Whitaker, the Director of the Illinois Department of Public Health at the time during which the work was undertaken, for his vision, guidance, and support. Lastly, we thank all participating families whose invaluable feedback helped shape and inform our interventions, enabling us to better serve the community. This research was funded in part by grant numbers 43280137 and 53283024 from the Illinois Department of Public Health. Additional support for the staff involved in this research has been provided by The Michael Reese Health Trust, Roe Health Policy Fund and The Centers for Disease Control and Prevention.

Declaration of Interest

The views expressed are those of the authors and do not necessarily represent the views of the funding agency. All authors are employed by the Sinai Health System in Chicago, IL. The authors report no other conflicts of interest. The authors alone are responsible for the content and writing of the article.