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

尽管哮喘护理干预项目在减少哮喘方面的有效性有强有力的证据基础 关于低收入少数族裔儿童的发病率，我们对如何最好地翻译和 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，重点是早期 学习、身体健康和家庭，并致力于实施循证方案，以促进 儿童的整体健康状况。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 对低资源社区组织的干预，这些组织为高危儿童提供服务。实施策略 在理论上经常被开发，并且可能不是为该环境量身定做的。MD ABC哮喘是一种多层次的 哮喘计划，包括工作人员和家庭哮喘教育培训，以及与 医疗服务提供者。该项目的总体目的是告知实施哮喘的最佳做法。 教育计划通过1)系统地评估干预地图的使用来制定量身定制的 与Head Start利益攸关方合作实施战略，2)检查工作人员和组织 与MD ABC哮喘实施相关的水平决定因素，以及3)评估定制的成功 关于执行结果和缺课及其他健康后果的执行战略。AS 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 使用实施研究综合框架(CFIR)的实施进程。Aim1将 专注于对Head Start员工和主管进行实施前评估，以提供量身定制的实施方案 使用干预地图的策略。目标2将是对执行情况的持续评估和支持 流程使用顺序混合方法方法。目标3将确定工作人员和组织 执行结果的决定因素，以告知Head Start中的国家可扩展性。结果将确定 通过与现有合作伙伴合作，在低资源环境下实施和可持续发展的创新方法 社区和政府机构以及评估综合多层次的影响效果 哮喘计划、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，并纳入 通过Head Start办公室在全国范围内管理哮喘的国家指导方针。

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.