Community Health Workers and Environmental Interventions for Children with Asthma: A Systematic Review
Community Health Workers and Environmental Interventions for Children with Asthma: A Systematic Review
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DOI：
10.1080/02770900902912638
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发表时间：
2009-01-01
影响因子：
1.9
通讯作者：
Kieckhefer, Gail
中科院分区：
文献类型：
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作者：
Postma, Julie;Karr, Catherine;Kieckhefer, Gail
系统地回顾了社区卫生工作者（CHW）提供的以家庭为基础的儿童哮喘环境干预措施。确定了7项PubMed/MEDLINE列出的随机对照试验，包括以下干预标准：（1）以家庭为基础;（2）由CHW提供;（3）提供给哮喘儿童家庭;（4）解决哮喘的多种环境触发因素。详细的研究设计，干预类型，和设置，干预，人口服务，和评价结果进行了抽象。成果评估是广泛和不统一的。类别包括改善健康结果的直接介质，如与吸烟相关的知识，触发减少行为和过敏原或暴露水平，以及与哮喘相关的健康结果：肺功能变化，药物使用，哮喘症状，活动限制和卫生保健利用。在少数研究中测量了健康结果的间接介导因素或对健康的心理社会影响。总体而言，这些研究一致确定了与CHW提供的干预措施相关的积极结果，包括哮喘症状减少，白天活动受限以及紧急和紧急护理使用。然而，触发减少行为和过敏原水平的改善，这些结果的假设介质，是不一致的。触发减少行为似乎与基于研究的资源提供有关。为了更好地了解CHW领导的环境干预措施引起哮喘相关健康结果变化的机制，需要有关介导触发控制（自我效能，社会支持）行为变化的理论概念的信息。此外，应考虑评估CHW作为诊所联络人的影响，以增加获得卫生专业人员的机会，补充临床教学，并改善哮喘药物的适当使用，以及它们对环境管理的影响。一个概念模型，确定未来的调查途径。
Community health worker (CHW)-delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; (2) delivered by a CHW; (3) delivered to families with children with asthma; and (4) addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies. Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model identifying pathways for future investigation is presented.