Peer-Administered Asthma Self-Management Intervention in Urban Middle Schools

项目概要/摘要： 儿童哮喘的健康差异持续存在，拉丁裔儿童的哮喘发病率增加。 中学生的发病率高于任何其他年龄组的儿童，但没有学校- 为这一群体制定的哮喘管理计划。为了解决这些问题，我们开发了 并试行了一种新的基于群体的干预：ASMAS（哮喘自我管理学校）在两个 城市拉丁裔哮喘儿童比例较高的地理区域：普罗维登斯、罗得岛和 圣胡安，波多黎各。ASMAS是一个4节，同侪促进哮喘自我管理干预具体 拉丁美洲中学（6 - 8年级）儿童的学校环境。它是由受过训练的拉丁裔高中 患有哮喘的低年级和高年级学生将基于指南的自我管理适应城市学校 这与拉丁裔儿童的文化背景是一致的。在我们的试点RCT中，ASMAS改善了 哮喘的结果和自我管理的目标群体。我们提出的方法涉及一个混合 设计包括一个大规模的随机对照试验，调查ASMAS的效果，并评估 执行过程的信息，以告知未来计划在更多的城市环境中测试ASMAS。我们的首要目标是 为了评估ASMAS对哮喘健康结果的影响（例如，控制，无症状天数，缺勤， 肺功能）和哮喘自我管理（技能、知识和自我效能、急救吸入器的可用性 和学校的行动计划）在普罗维登斯，RI和 圣胡安，PR（每个研究中心216例;每个条件72例）。6至8年级的中学生将被随机招募， 分配至1）ASMAS，或2）哮喘教育+儿童健康控制条件，或3）无治疗对照 条件（每个研究中心9组，每组8名儿童）。学生和主要照顾者 评估将在基线、治疗结束（干预后立即进行）以及3个月、4个月时进行 干预后的后续行动。我们的第二个目标是进行一个混合方法、多利益攸关方的进程 使用RE-AIM框架进行评估，48-50与学生，护理人员，HS同行，学校管理人员 以及更多的社区利益相关者投资于支持学生的哮喘护理。我们将开始 与主要利益攸关方一起制定实施战略，以便更好地为未来的大规模 评估ASMAS的有效性及其在其他城市中心的实施。相对于 对照组，超过1年，我们预计ASMAS参与者将改善哮喘结局， 管理我们还预计，对哮喘结果的治疗效果将通过自我调节的变化来介导。 在所有儿童的管理，并在RI儿童的文化压力和语言能力的调节。 拟议的工作提供了一个关键的机会，以评估ASMAS改善儿童哮喘的结果 在更大的范围内，开发可持续性和未来传播的途径， 社区利益相关者。

Project Summary/Abstract: Health disparities in pediatric asthma persist, with Latino children demonstrating increased asthma morbidity. Middle school children have greater morbidity than children from any other age group, yet there are no school- based asthma management programs developed for this group. To address these gaps, we have developed and piloted a novel group-based intervention: ASMAS (Asthma Self-MAnagement in Schools) in two geographic areas with a high proportion of urban, Latino children with asthma: Providence, Rhode Island, and San Juan, Puerto Rico. ASMAS is a 4-session, peer-facilitated asthma self-management intervention specific to the school setting for Latino middle school (6th-8th graders) children. It is delivered by trained Latino High School Juniors and Seniors with asthma, adapts guidelines-based self-management to the urban school setting, and is consistent with Latino children's cultural backgrounds. In our pilot RCT, ASMAS improved asthma outcomes and self-management for the targeted groups. Our proposed approach involves a hybrid design including a large-scale randomized, controlled trial investigating the effect of ASMAS, and an evaluation of the implementation process to inform future plans to test ASMAS in additional urban settings. Our first aim is to evaluate the effects of ASMAS on asthma health outcomes (e.g., control, symptom free days, absences, lung function) and asthma self-management (skills, knowledge and self-efficacy, availability of rescue inhaler and action plan at school) in a sample of 432 Latino middle school children with asthma in Providence, RI and San Juan, PR (216 per site; 72 per condition). 6th to 8th grade middle schoolers will be enrolled then randomly assigned to 1) ASMAS, or 2) Asthma Education plus Child Health control condition, or 3) a no treatment control condition (9 groups of each condition per site; 8 children per group). Student and primary caregiver assessments will occur at baseline, end of treatment (directly following the intervention), and at three, 4-month post intervention follow-ups. Our second aim is to conduct a mixed-methods, multi-stakeholder process evaluation using the RE-AIM framework,48-50 with students, caregivers, HS Peers, school administrators and additional community stakeholders invested in supporting students' asthma care. We will begin to develop implementation strategies with key stakeholders to better prepare for future large-scale evaluation of the effectiveness of ASMAS and its implementation in additional urban centers. Relative to controls, over 1 year, we expect that ASMAS participants will have improved asthma outcomes and self- management. We also expect treatment effects on asthma outcomes will be mediated through changes in self- management in all children, and moderated by acculturative stress and language proficiency in RI children. The proposed work offers a critical opportunity to evaluate ASMAS for improving asthma outcomes for children at high risk on a larger-scale and to develop avenues for sustainability and future dissemination with state and community stakeholders.