An Asthma Collaboration to Reduce Childhood Asthma Disparities on the Navajo Nation

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PROJECT SUMMARY/ABSTRACT Asthma prevalence among children on the Navajo Nation, the largest tribal reservation in the United States, is 2-3 times that of the general population and fueled by health disparities that include devastating poverty, multiple environmental pollutants, and large travel distances to obtain healthcare. Delivery of evidence-based asthma care through the Indian Health Service (IHS), the only healthcare system on the reservation, is inconsistent. While schools and communities identify pediatric asthma as a strong concern, no comprehensive asthma care implementation plan has been previously introduced. Therefore, this proposed study will combine two previously tested programs, one focused on training providers and one on school-based education and monitoring, to build a comprehensive, integrated, team-based Asthma Care Implementation Program to address medical care, family, home, and community to improve the health of Navajo children with asthma. A one-year engagement phase has resulted in strong support from Navajo Nation organizations including the President and Vice President of the Navajo Nation, governmental organizations, healthcare centers, schools, and communities in the three participating agencies (Fort Defiance, Chinle, and Tuba City). Approval of the proposed study by the Navajo Nation Human Research Review Board has been obtained. Key recommendations from communities including use of existing resources such as the Navajo Epidemiology Center, Navajo Health Department, local media, lay health workers, and ongoing involvement of stakeholders are included in this plan. Using a stepped-wedge design, the intervention will be introduced sequentially into three agencies. A mixed-methods analysis strategy will be employed that includes annual examination of asthma exacerbations through the IHS database (primary outcome), interviews with 300 families with a child with asthma, and key informant interviews with healthcare providers and school teachers and nurses. During the sustainability phase, meetings will be held with multiple organizations including local chapter houses to share outcome data, gather feedback, and plan for future dissemination to other agencies and reservations. The RE-AIM framework will be employed to evaluate the implementation process and facilitate dissemination to other tribal populations.