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.
Highlights
Asthma exacerbations can be readily prevented and controlled with proper inhaled corticosteroid medication usage and the reduction of environmental triggers [1,2]
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
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
Summary
Asthma exacerbations can be readily prevented and controlled with proper inhaled corticosteroid medication usage and the reduction of environmental triggers [1,2]. Triggers and Control: no differences were seen between treatment arms at any time point for Behavior Summary Score (Table 3), the Mailings arm had an increase in the proportion of participants with cotinine exposure at 5-months (33.3% to 62.5%, p=0.02). In contrast to most pediatric asthma CHW studies, Project CURA did not give families cleaning supplies or equipment, it tested the intervention in a population with the highest reported asthma prevalence and morbidity, and it objectively measured adherence and trigger outcomes. In the ESC, no differences were seen in outcomes between arms at any time point with one exception: the CHW arm had lower odds of having an ICS at 12-months but this difference was not significant in secondary analyses excluding those who did not receive intervention. Further investigation of the CHW model is needed to better determine its real-life efficacy and practical expectations for integrating CHWs into the healthcare delivery system
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