Addressing Social Determinants of Health in Disadvantaged Children with Asthma

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PROJECT SUMMARY / ABSTRACT Our diversity supplement proposal, “Addressing Social Determinants of Health in Disadvantaged Children with Asthma,” seeks to provide Mfonobong Udoko, MD, experience in conducting qualitative methodology research to assess and manage social determinants of health (SDOH). Dr. Udoko will utilize our UG3 parent grant to evaluate the role of SDOH in children with asthma, ages 5 to 12 years, from low-income communities. We are applying community-based participatory methods with high risk populations and communities to contextualize dissemination and implementation (D&I) of our Colorado school-based asthma program (Col- SBAP) that reduces asthma exacerbations and missed school days, while also addressing SDOH which our pilot identified as a major driver of asthma disparities. Our dissemination trial will include two interventions: our evidence-based Col-SBAP and an approach to key SDOH. This two-step level of intervention, called Stop Asthma Attacks (SAA), is designed for sustainable delivery by school asthma navigators and school nurses who coordinate with primary care and community resources. In partnership with our community stakeholders, the Exploration, Preparation, Implementation, Sustainment (EPIS) D&I framework is being applied during the UG3 planning phase to iteratively adapt our current implementation guide to tailored implementation plans that meet local community and site-specific needs, resources and priorities (EPIS Phases 1 & 2). We will then conduct a UH3 dissemination trial with a randomized stepped-wedge study design in asthma “hot spot” school systems across five Colorado regions to evaluate implementation strategies across these school systems (EPIS phase 3, UH3 trial) and to apply the work from EPIS phases 1-3 to develop a “dissemination playbook” to guide future program adoption by other school systems (EPIS Phase 4). Dr. Udoko will obtain input from various stakeholders on assessing and providing resources to address SDOH. This information will be used to develop our DECIPHeR dissemination playbook for our staff to obtain information on SDOH, enhance their ability to refer families to appropriate resources and then follow up on these referrals. The following Specific Aims will support our parent UG3 grant: Supplement Aim 1a and 1b. Compare the strengths and limitations of 2 different approaches for SDOH screening + intervention from multiple stakeholders: a) self-assessment by caregivers using a printed questionnaire; b) navigator led interview of caregivers based on a questionnaire. Supplement Aim 1c. Across stakeholder groups, identify characteristic features of current SDOH screening + intervention that leads to successful management of SDOH needs. Dr. Udoko will provide important information as a companion to our DECIPHeR “dissemination playbook” on methods to obtain information on SDOH and to link families to the appropriate resources, assure their follow-up, and improve communication within our parent grant DECIPHeR communities.