Adapting and implementing an evidence-based asthma counseling intervention for resource-poor populations

Abstract

Objective: To report implementation strategies and outcomes of an evidence-based asthma counseling intervention. The Head-off Environmental Asthma in Louisiana (HEAL) intervention integrated asthma counseling (AC) capacity and addressed challenges facing children with asthma in post-disaster New Orleans. Methods: The HEAL intervention enrolled 182 children (4–12 years) with moderate-to-severe persistent asthma. Recruitment occurred from schools in the Greater New Orleans area for one year. Participants received home environmental assessments and tailored asthma counseling sessions during the study period based on the National Cooperative Inner City Asthma Study and the Inner City Asthma Study. Primary (i.e., asthma symptoms) and secondary outcomes (i.e., healthcare utilization) were captured. During the study, changes were made to meet the demands of a post-hurricane and resource-poor environment which included changes to staffing, training, AC tools, and AC sessions. Results: After study changes were made, the AC visit rate increased by 92.3%. Significant improvements were observed across several adherence measures (e.g., running out of medications (p = 0.009), financial/insurance problems for appointments (p = 0.006), worried about medication side-effects (p = 0.01), felt medications did not work (p < 0.001)). Additionally, an increasing number of AC visits was modestly associated with a greater reduction in symptoms (test-for-trend p = 0.059). Conclusion: By adapting to the needs of the study population and setting, investigators successfully implemented a counseling intervention that improved participant behaviors and clinical outcomes. The strategies for implementing the AC intervention may serve as a guide for managing asthma and other chronic conditions in resource-poor settings.

Keywords:

• Asthma counselors
• post-disaster
• case management
• chronic disease counseling
• environmental triggers

Acknowledgements

The authors would also like to thank the following institutions, investigators, and staff: Tulane University School of Public Health and Tropical Medicine, Maureen Lichtveld (principal investigator), Faye Grimsley (investigator), LuAnn White (investigator), William Hawkins (program management), Melissa Owsiany (senior program coordinator), Shannon DeGruy, Dorothy Paul, Latasha Barlow, Nicole Bell, Erica Harris (home evaluators); Tulane University Health Sciences Center, Jane El-Dahr (investigator); Tulane University School of Medicine, Maxcie Sikora (physician); Tulane Clinical and Translational Research Center of Tulane and Louisiana State Universities Schools of Medicine, Mary Meyaski-Schluter, Virginia Garrison, Erin Plaia, Annie Stell, Jim Outland, Shanker Japa, Charlotte Marshall (nursing staff); New Orleans Health Department, Kevin Stephens (principal investigator), Mosanda Mvula (investigator), Stacey Denham, Margaret Sanders, Claire Hayes (asthma counselors), Alfreda Porter, Tenaj Hampton, Angela Sarker (community health workers), Mamadou Misbaou Diallo, Shawanda Rogers, David Ali (recruiters), Doryne Sunda-Meya, Ariska Fortenberry (administrative), Florietta M. Stevenson (personnel); Louisiana State University Health Sciences Center School of Nursing, Yvonne Sterling (investigator); Louisiana State University Health Sciences Center, Ken Paris (physician); National Institute of Environmental Health Sciences, Patricia Chulada (health scientist administrator); National Institute of Child Health and Human Development, William Martin II (principal investigator); Visionary Consulting Partners, LLC, Eleanor Thornton (investigator); Constella Group, LLC, Rich Cohn (investigator), Keith Bordelon (study coordinator); Rho, Inc, Herman Mitchell (principal investigator), Suzanne Kennedy (investigator), John Lim (data manager), Gina Allen (research associate), Jeremy Wildfire (statistician), and Rebecca Z. Krouse (statistician). Merck Childhood Asthma Network, Inc, Floyd J. Malveaux (consultant). In addition, David Schwartz (University of Colorado, past Director of NIEHS at time of HEAL) for his innovative input and willingness to support the project early in the process.

Declaration of interest

The authors have no financial and/or personal relationships to disclose that could inappropriately influence (bias) their work. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This project was funded by the National Center of Minority Health and Health Disparities (NCMHD, now the NIMHD); the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health under Contract number NO1-ES-55553; and the Merck Childhood Asthma Network, Inc.(MCAN). Public-private funding provided by the NIH and MCAN was managed under the auspices of the Foundation for the National Institutes of Health. Established by the United States Congress to support the mission of the NIH—improving health through scientific discovery in the search for cures—the Foundation for the NIH is a leader in identifying and addressing complex scientific and health issues. The Foundation is a non-profit, 501(c) (3) charitable organization that raises private-sector funds for a broad portfolio of unique programs that complement and enhance the NIH priorities and activities. [Additional information about the Foundation for the NIH is available online (http://www.fnih.org/).] The Merck Childhood Asthma Network, Inc. is a separately incorporated, nonprofit, 501(c) (3) organization funded by the Merck Foundation, the philanthropic arm of Merck & Co., Inc. Other organizations that contributed include the National Toxicology Program (NIEHS), the U.S. Environmental Protection Agency (Cincinnati, OH), and the de Laski Family Foundation. The Clinical and Translational Research Center of Tulane and Louisiana State Universities Schools of Medicine was supported in whole or in part by funds provided through the Louisiana Board of Regents RC/EEP.The authors would also like to acknowledge the following funders of HEAL: The National Center of Minority Health and Health Disparities (NCMHD, now the NIMHD); the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health under Contract number NO1-ES-55553; and the Merck Childhood Asthma Network, Inc.(MCAN). Other organizations that contributed include the National Toxicology Program (NIEHS), the U.S. Environmental Protection Agency (Cincinnati, OH), and the de Laski Family Foundation. The Clinical and Translational Research Center of Tulane and Louisiana State Universities Schools of Medicine was supported in whole or in part by funds provided through the Louisiana Board of Regents RC/EEP.