Challenges to Childhood Asthma Intervention Delivery in Hard-to-Reach Small Rural Communities

Abstract

The burden of asthma in most rural America is mirrored in part by the state of West Virginia, with a 2.2% higher rate than the national average. Most rural residents live in small communities of population size < 3000. While studies have reported on asthma management interventions elsewhere, only a few involved such small rural environments. Because of the unique socioeconomic demographics and challenges faced by these communities—including geographic isolation, indoor exposures to secondary tobacco smoke, and limited access to health care—school children and their families should be educated in asthma management skills. This article focuses on a school-based intervention approach for students and an assessment of their parents’ support and knowledge gained during the intervention. Although the school-based asthma education increased participating students’ asthma management skills, 3 major challenges emerged: Some parents exhibited persistent adverse behaviors in controlling asthma triggers in their homes; a small percentage of parents had little knowledge of irritants or asthma triggers; and some parents were unwilling to consent to their children’s participation in a school-based asthma education intervention. These challenges may be important to address in future asthma interventions aimed at hard-to-reach small rural communities.