Puerto Rico Asthma Integrated Response Program (PR-AIR)

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Project Summary/Abstract Children of Puerto Rican (PR) descent have higher rates of asthma prevalence and morbidity than children from any other ethnic group. Children residing on the Island of PR have even higher asthma prevalence than Mainland PR children. We propose to implement and evaluate the Puerto Rico-Asthma Integrated Response Program (PR-AIR) to address pediatric asthma disparities in San Juan, PR, an area of high asthma burden. PR-AIR integrates evidence-based interventions in home and school settings, and enhances communication between families, schools, and health care providers. During Phase 1, we will convene a community collaborative of stakeholders that will provide input throughout the project, and use in-depth interviews to identify community needs, barriers, and facilitators to enable PR-AIR implementation. We will identify which characteristics of our existing evidence-based virtual and in-person interventions in home and school settings require fidelity-consistent modifications and use stakeholder input and matching of barriers to implementation strategy selection to identify methods to enhance PR-AIR uptake. During Phase 2, we will use a hybrid type III effectiveness-implementation design, evaluating low-intensity (virtual) and high-intensity (in-person) methods of implementation of PR-AIR. We will provide PR-AIR sequentially to 12 communities identified with high asthma burden through geospatial mapping using a cluster randomized, stepped wedge trial design, delivering PR-AIR to 400 children with asthma ages 2-12. We will use a mixed-methods approach to assess the impact of our implementation strategies on PR-AIR reach, adoption, implementation, and maintenance, and evaluate effectiveness of PR-AIR on individual-level (asthma control, quality of life) and community-level (health care utilization, school absences) outcomes. PR-AIR builds on a 20-year collaboration between our research teams in RI and PR, with an investment in advancing knowledge of multi-level factors affecting pediatric asthma disparities and reducing morbidity in children through evidence- based, sustainable interventions.