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

项目摘要/摘要 美国最大的部落保留地纳瓦霍民族的儿童哮喘患病率 各州的这一比例是普通人口的2-3倍，并受到健康差距的推动，其中包括毁灭性的 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)提供循证哮喘护理，这是世界上唯一的卫生保健系统 预订，是不一致的。虽然学校和社区认为儿童哮喘是一个强烈的问题，但没有 全面哮喘护理实施方案此前已出台。因此，这项建议 这项研究将结合两个以前测试过的项目，一个侧重于培训机构，另一个侧重于校本 教育和监测，以建立全面、集成、以团队为基础的哮喘护理实施 解决医疗、家庭、家庭和社区问题的计划，以改善纳瓦霍儿童的健康 哮喘。为期一年的接触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、钦勒和图巴市)的中心、学校和社区。 纳瓦霍民族人类研究审查委员会已经批准了这项拟议的研究。钥匙 来自社区的建议，包括使用现有资源，如纳瓦霍流行病学 中心、纳瓦霍卫生局、当地媒体、非专业卫生工作者以及利益攸关方的持续参与 都包括在这项计划中。采用阶梯式楔形设计，干预措施将按顺序引入 三家机构。将采用混合方法分析策略，包括年度检查 通过IHS数据库加重哮喘(主要结果)，访谈300个有孩子的家庭 哮喘，以及与医疗保健提供者、学校教师和护士的关键线人访谈。在.期间 在可持续性阶段，将与包括地方分会在内的多个组织举行会议，以 共享结果数据，收集反馈，并计划将来传播给其他机构和预订部。 将采用RE-AIM框架来评估执行进程并促进传播 传给其他部落人口。

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.