Abstract
BackgroundThe objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity.MethodsUsing a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5–12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI).ResultsFamilies received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012).ConclusionsThe CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.
Highlights
The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity
While only 40% of children had Childhood Asthma Control Test (cACT) scores indicating poor asthma control over the past 30 days, 74% were uncontrolled over the past year based on the EPR3 guidelines for control that include emergency room or hospitalization
While the small sample size and lack of a control group limits our interpretation of intervention effects, we demonstrated feasibility and potential effects of a CHW intervention for children with both asthma and obesity
Summary
The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity. Obese children with asthma use more medicine, wheeze more, and have more unscheduled emergency department visits than nonobese children with asthma [4] Despite these strong associations, interventions targeting children with both asthma and obesity are limited [5,6,7,8,9]. Interventions targeting children with both asthma and obesity are limited [5,6,7,8,9] This gap in the field prompted the formation of the Community United to Raise Awareness: Asthma and Active Living study (CURA 2) with the goal of developing a behavioral intervention for children with both asthma and obesity. The CURA 2 intervention was tested in a proof of concept study to assess if these changes resulted in a feasible
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