A Family Intervention for Pediatric Asthma Self-Management in Puerto Ricans

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DESCRIPTION (provided by investigator): Puerto Rican children in the United States experience the highest rates of asthma and asthma exacerbations of all racial/ethnic groups. This application focuses on two modifiable risk factors for asthma exacerbations-high levels of home asthma triggers and poor adherence to inhaled corticosteroid medication. Changing these risk factors requires interventions that can maximize the asthma management skills of both the child and the parent. This exploratory R21 application compares an asthma self-management intervention, delivered to the family and tailored to their needs and cultural beliefs, to standard asthma education on these two risk factors for asthma exacerbations in high-risk Puerto Rican teens and pre-teens ages 8-16 years old. The intervention will be a series of home visits provided by Puerto Rican community health workers. During home visits, the family will be educated using a standard asthma Core Curriculum which is tailored to individual needs, strengths, and beliefs using a Toolkit. The Core Curriculum includes the asthma topics of medications, symptom recognition, and home triggers. The Toolkit incorporates specific self-management skills training in environmental rearrangement, problem solving, self-monitoring, and enlisting social support into the Core Curriculum. It also includes cultural integration which is used to connect cultural beliefs with asthma education and self-management skills. Specific Aim 1 is to test the ability of this family-focused, tailored self-management intervention to reduce asthma exacerbation risk factors in Puerto Rican teens and pre-teens with asthma. Our hypotheses are that the intervention group will score at least one point less than the control group on the trigger behavior summary score and will have at least 20 per cent improved adherence to inhaled corticosteroid medications compared to controls after the active intervention phase. Specific Aim 2 is to test if changes in asthma exacerbation risk factors associated with this intervention are sustained 8 months after the completion of the active intervention. The efficacy of this intervention will be tested using a behavioral randomized controlled trial design featuring 50 subjects and a 1:1 randomization scheme. The long-term goal is to apply these pilot data to the design and implementation of a larger behavioral randomized controlled trial that will test the efficacy of a similar asthma intervention to improve asthma control in Puerto Rican children. The innovation of this intervention is that it provides specific asthma self-management education that is tailored to the individual family to promote cultural sensitivity and skills development. The intervention is evaluated through the innovative integration of methodologies used in behavioral clinical trial efficacy studies and in community-based participatory research. The investigators in this application have significant experience with community agencies serving the target population and with community-based participatory research. The data generated from this research will improve our understanding of how to improve asthma management in Puerto Rican children. PUBLIC HEALTH RELEVANCE: Puerto Rican children in the United States experience the highest rates of asthma and asthma exacerbations of all racial/ethnic groups. The data generated from this research will aid our understanding of how to improve asthma management and reduce asthma exacerbations in Puerto Rican children and adolescents. The participatory design serves to build community capacity for research and improve research quality and effectiveness.