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

项目总结/摘要 美国最大的部落保留地纳瓦霍族的儿童哮喘患病率 在美国，是一般人口的2-3倍，并受到健康差距的推动，包括毁灭性的 贫困、多种环境污染物和长途旅行以获得医疗保健。交付 通过印度卫生服务（IHS）提供基于证据的哮喘护理，这是印度唯一的医疗保健系统。 保留，不一致。虽然学校和社区将儿童哮喘确定为一个强烈关注的问题， 此前已出台了全面的哮喘护理实施计划。因此，本建议 一项研究将联合收割机结合两个以前测试过的项目，一个侧重于培训提供者，另一个侧重于学校 教育和监测，以建立一个全面的，综合的，以团队为基础的哮喘护理实施 解决医疗保健、家庭、家庭和社区问题的方案，以改善纳瓦霍儿童的健康， 哮喘为期一年的参与阶段得到了纳瓦霍民族组织的大力支持 包括纳瓦霍民族的总统和副总统，政府组织，医疗保健， 三个参与机构（迪法恩斯堡、钦勒和土巴城）的中心、学校和社区。 纳瓦霍民族人类研究审查委员会已批准拟议的研究。关键 社区的建议，包括使用现有资源，如纳瓦霍流行病学 中心、纳瓦霍卫生部、当地媒体、非专业卫生工作者以及利益相关者的持续参与 都包含在这个计划中。使用阶梯楔形设计，干预措施将依次引入 三个机构。将采用混合方法分析战略，包括每年审查 通过IHS数据库（主要结局），对300个有孩子的家庭进行访谈 与哮喘，和关键线人采访医疗保健提供者和学校教师和护士。期间 在可持续发展阶段，将与包括地方分会在内的多个组织举行会议， 分享成果数据，收集反馈，并计划今后向其他机构和保留地传播。 RE-AIM框架将用于评估实施过程和促进传播 其他部落人口。

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.