COMMUNITY PARTNERSHIP TO REDUCE ASTHMA DISPARITIES

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DESCRIPTION (provided by applicant): Pediatric asthma is increasingly common among minority children, and results in considerable healthcare disparity. This application seeks to establish a Community Partnership between Rhode Island Hospital and the Providence Community Health Centers to conduct a randomized, controlled trial to increase use of controller medications for asthma among Latino and African-American children. A Community Advisory Board of parents and key informants will provide ongoing input regarding treatment implementation. Families with children who have persistent asthma symptoms will be enrolled. Three groups will be recruited (N=240 total): African-American families, Latino families who prefer health care in Spanish, and Latino families who prefer health care in English. All families will be enrolled in a brief baseline period. Children who are prescribed oral or inhaled controller medications will have medication use monitored electronically. Research staff will also collect data regarding baseline medication use from pharmacy records and insurance claims. Asthma knowledge, medication beliefs, medication adherence, and asthma morbidity will be assessed at baseline, end of treatment, and at 3-month intervals until 1 year post-treatment. After completing a baseline, all families will attend a group-based asthma education class in their own Community Health Center (one of five CHC's). Families will the be randomized to one of two nurse delivered interventions, either 1) a Standard Care (SC) condition, which emphasizes use of symptom monitoring, peak flow meter, trigger control measures, and a written action plan, or 2) a Medication Adherence (MA) condition, which assesses use of alternative medications, addresses concerns regarding use of controller medications, and uses problem-solving techniques to address barriers to medication use. Follow-up is conducted by researcher assistants at 3-, 6-, 9-, and 12-month time points post-intervention. It is expected that both interventions will increase asthma knowledge, but the MA intervention will yield greater controller medication use and decreased morbidity. It is further expected that differences in medication adherence post-treatment will be mediated by medication beliefs. Lastly, it is anticipated that within the Latino groups, Latinos with low English proficiency will demonstrate the greatest changes from baseline on medication adherence and morbidity. A Sustainability Advisory board will provide guidance regarding project implementation in the community beyond the life of the grant.