Addressing Social Determinants of Health in Disadvantaged Children with Asthma

项目总结/摘要 我们的多元化补充提案，“解决残疾儿童健康的社会决定因素 与哮喘，”旨在提供Mfonobong Udoko，医学博士，在进行定性方法的经验， 评估和管理健康社会决定因素的研究。Udoko博士将利用我们的UG 3母公司 赠款用于评估SDOH在低收入社区5至12岁哮喘儿童中的作用。 我们正在对高危人群和社区采用以社区为基础的参与性方法， 将我们的科罗拉多学校哮喘项目（Col. SBAP），减少哮喘恶化和缺课，同时还解决了我们 飞行员被确定为哮喘差异的主要驱动因素。我们的传播试验将包括两种干预措施： 基于证据的Col-SBAP和关键SDOH的方法。这两个步骤的干预水平，称为停止 哮喘发作（SAA）是专为学校哮喘导航员和学校护士可持续提供 负责协调初级保健和社区资源。与我们的社区利益相关者合作， “探索、准备、实施、维持”（EPIS）的D&I框架正在应用于 UG 3规划阶段，反复调整我们当前的实施指南，以适应定制的实施计划 满足当地社区和特定地点的需求、资源和优先事项（环境规划信息系统第1和第2阶段）。然后我们将 在哮喘“热点”学校进行UH 3传播试验，采用随机分级楔形研究设计 在五个科罗拉多地区的系统，以评估这些学校系统的实施战略 (EPIS第3阶段，UH 3试验），并应用EPIS第1-3阶段的工作，制定“传播剧本” 指导其他学校系统未来采用该计划（EPIS第4阶段）。Udoko博士将从 评估和提供资源，以解决SDOH的各种利益相关者。此信息将用于 制定我们的DECIPHeR传播剧本，让我们的员工获得有关SDOH的信息，提高他们的 有能力将家庭介绍给适当的资源，然后对这些介绍采取后续行动。以下具体 目标将支持我们的母公司UG 3赠款：补充目标1a和1b。比较的优势和局限性 2种不同的SDOH筛查方法+多个利益相关者的干预：a）自我评估， 使用打印问卷的护理者; B）基于问卷的导航员引导的护理者访谈。 补充目标1c。在利益相关者群体中，确定当前SDOH筛查的特征+ 成功管理SDOH需求的干预措施。Udoko博士将提供重要的 作为我们的DECIPHeR“传播手册”的配套信息，介绍获取信息的方法， 将家庭与适当的资源联系起来，确保他们的后续行动，并改善沟通 在我们的母公司DECIPHeR社区内。

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.