Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago

Abstract

Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago. Methods: This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics. Results: While most of the participants had uncontrolled persistent asthma, < 50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n = 51), the CHW arm had lower odds of having an ICS (OR = 0.2; p = 0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n = 50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p < 0.01) and 14.2% more steps correct at 12 months (p < 0.01). Conclusions: While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.

• Hispanic
• community health worker
• behavioral intervention
• pediatric
• randomized controlled trial

Acknowledgements

Special thanks go to Dorian Ortega, Joann Lugardo and Adriana Rodriguez who recruited the participants and collected all the data. Other study investigators include Juana Ballesteros, Raul Echevarria, Rose De Jesus, Lynda Powell and John Kane. We also thank our community partners: The Puerto Rican Cultural Center, The Greater Humboldt Park Community of Wellness, Women Living with Hope, New Life Covenant Church, West Town Leadership United; Norwegian American Hospital, Erie Family Health Centers, Mobile C.A.R.E., Dr, Jack Leong at Cicero Prompt Care; and Saints Mary and Elizabeth Medical Center. Finally we thank the families of Project CURA – La Comunidad Unida Retando el Asma.

Declaration of interest

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

This study is funded by The National Heart Lung and Blood Institute of the National Institutes of Health: 1R21HL087769-01A1 and 1R21HL093346-01A1 (Clinical Trials ID NCT01065883 and NCT01061424). G. Mosnaim owns stock options and serves on the scientific advisory board for Electrocore.