Implementation of a multilevel program to reduce asthma symptoms in urban preschoolers

尽管哮喘护理干预计划在减少哮喘方面的有效性有很强的证据基础， 低收入少数民族儿童的发病率，我们对如何最好地转化和 将这些有效的干预措施扩大到可持续的、基础广泛的项目中，以减少已知的哮喘 健康差距。Head Start（HS）每年为100多万低收入儿童提供服务， 学习，身体健康和家庭，并致力于实施基于证据的计划，以促进 整体儿童福利。目前尚不清楚如何最好地扩大和实施这些基于证据的哮喘 对资源匮乏的社区组织采取干预措施，为处境危险的儿童提供服务。执行战略 经常是理论上的，可能不适合设置。MD ABC哮喘是一种多水平的 哮喘计划，包括工作人员和家庭哮喘教育培训以及综合护理， 医疗供应商。该项目的总体目的是告知实施哮喘的最佳实践， 教育计划，1）系统地评估干预映射的使用，以制定一个量身定制的 实施战略，与领先的利益攸关方合作，2）审查工作人员和组织 与实施MD ABC哮喘相关的水平决定因素，以及3）评估定制的 关于执行成果和缺课及其他健康成果的执行战略。作为 作为实施的一部分，我们将进行多阶段顺序混合方法研究，以告知和评估 实施研究综合框架（CFIR）。Aim1将 重点对Head Start工作人员和董事进行实施前评估，为量身定制的实施提供信息 使用干预映射的策略。目标2将是对执行工作的持续评价和支持 使用顺序混合方法的过程。目标3将确定工作人员和组织 执行成果的决定因素，为“开端”计划内的国家可扩展性提供信息。结果将确定 在资源匮乏的情况下，通过与现有的 社区和政府机构，以及评估综合多层次的影响有效性 哮喘项目、缺课、哮喘控制和医疗保健利用。成功实施 这种有效的干预措施有可能被纳入联邦指导方针， 通过领先办公室在全国范围内制定哮喘管理国家指南。

Despite a strong evidence-base for the efficacy of asthma care intervention programs in reducing asthma morbidity among low-income minority children, gaps remain in our understanding of how best to translate and scale up these efficacious interventions into sustainable, broad-based programs that reduce known asthma health disparities. Head Start (HS) serves over one million low income children each year by focusing on early learning, physical health, and family and is committed to implementing evidence based programs to promote overall child wellbeing. It is unknown how to best scale up and implement these evidence based asthma interventions into low resource community organizations that serve children at risk. Implementation strategies are frequently developed atheoretically and may not be tailored to the setting. MD ABC Asthma is a multilevel asthma program that includes both staff and family asthma education training as well an integrated care with medical providers. The overall purpose of this project is to inform best practices of implementation of an asthma education program by 1) systematically evaluating the use of intervention mapping to develop a tailored implementation strategy in partnership with Head Start stakeholders, 2) examining both staff and organizational level determinants associated with implementation of MD ABC Asthma, and 3) evaluating the success of tailored implementation strategies on implementation outcomes and school absences and other health outcomes.. As part of this implementation, we will conduct a multiphase sequential mixed methods study to inform and evaluate the implementation process using the Consolidated Framework of Implementation Research (CFIR). Aim1 will focus on a pre-implementation evaluation of Head Start staff and directors to inform a tailored implementation strategy using intervention mapping. Aims 2 will be an ongoing evaluation and support of the implementation process using a sequential mixed methods approach. Aim 3 will identify both staff and organizational determinants of implementation outcomes to inform national scalability within Head Start. Results will identify innovative methods for implementation and sustainability in low resource settings by partnering with existing community and government agencies as well as evaluate the impact effectiveness of an integrated multilevel asthma program, school absences, asthma control, and healthcare utilization. Successful implementation of this effective intervention has the potential to be included in federal guidelines and integrated into national guidelines on management of asthma nationally through the Office of Head Start.