A+ Asthma Rural Partnership

农村社区的环境、社会经济、心理社会和家庭因素使儿童容易患上包括哮喘在内的慢性健康疾病。哮喘是最常见的儿童慢性疾病，在美国5-14岁的儿童中有7.4%受到影响。这对这些儿童的生活质量有重大影响。缺乏解决农村学龄儿童哮喘教育独特需求的信息。本研究的目的是评价以学校为基础的哮喘教育干预对农村小学生哮喘生活质量的影响。目的1：1~5年级儿童的生活质量、卫生保健利用、哮喘知识、自我效能、旷课和哮喘药物使用情况；目标2：家长/照顾者的生活质量、哮喘知识、自我效能和哮喘管理行为；目标3：学校卫生人员的哮喘知识、自我效能、哮喘管理和沟通频率。主要研究结果是儿童的生活质量。来自马里兰州东海岸六个农村县的294名1-5年级哮喘儿童将被录取。这些县将被分为两个县组，标准对照组和干预组，根据学生总入学人数、性别和种族进行匹配。标准对照组(n=147)的儿童和父母/照料者将收到印刷的哮喘教育/材料。SHP将收到印刷和视频哮喘管理材料和峰值流量计(PPM)。干预组(n=147)的儿童和父母/照料者将获得与标准对照组相同的材料。此外，干预组的儿童将收到由SHP举办的4小时A+哮喘儿童工作坊、我的哮喘涂色书、双月通讯、峰值流量计和间隔装置。家长/照顾者将获得一个小时的工作坊和一套特别设计的关于农村哮喘管理的教育材料。儿童和父母/照顾者都将接受A+哮喘农村社区卫生工作者((CHWS)的服务。干预组的儿童将接受6小时的哮喘乡村训练，以及接受过特别训练的A+哮喘乡村护士顾问的服务，指导儿童哮喘和妇幼保健院管理。A PLUS哮喘RNC将协助举办儿童工作坊和家长/照顾者工作坊，社区卫生服务中心将对缺席工作坊的父母或经常缺课的儿童进行家访。将使用广义线性建模和协方差分析的扩展，在一个学年期间评估方案基线和方案结束时具体目标中描述的成果衡量的差异。主要假设是，与标准控制组相比，干预组儿童的生活质量将有显著改善。这项研究的发现将对临床医生、研究人员和卫生政策制定者具有重要意义。

Environmental, socioeconomic, psychosocial, and familial factors in rural communities predispose children to chronic health conditions, including asthma. Asthma is the most common chronic disease of childhood, affecting 7.4 percent of children aged 5-14 years in the United States. It has a significant impact on the quality of life of these children. There is a lack of information addressing the unique needs of asthma education for rural school children. The objective of this study is to evaluate the effectiveness of a school-based asthma educational intervention on the quality of life of rural elementary school children with asthma. The specific aims are to evaluate the effectiveness of the intervention on: Aim 1: quality of life, health care utilization, asthma knowledge, self-efficacy, school absenteeism, and use of asthma medications of children in grades 1-5; Aim 2: quality of life, asthma knowledge, self-efficacy, and asthma management practices of parents/caregivers; and Aim 3: asthma knowledge, self-efficacy, asthma management, and frequency of asthma communications of school health personnel (SHP). The primary study outcome is children's quality of life. A total of 294 children in grades 1-5 with asthma from six rural counties on the Maryland Eastern Shore will be enrolled. These counties will be divided into two county groups, a standard control and an intervention, matched for total student enrollment, gender, and ethnicity. Children and parents/caregivers in the standard control group (n=147) will receive printed asthma educational/materials. SHP will receive printed and video asthma management materials and peak flow meters (PFMs). Children and parents/caregivers in the intervention group (n=147) will receive the same materials as the standard control group. In addition, children in the intervention group will receive a 4-hour A plus Asthma Children's Workshop given by SHP, My Asthma Coloring Book, bimonthly newsletters, peak flow meters, and spacer devices. Parents/caregivers will receive a one-hour workshop and a specially designed packet of educational materials about rural related asthma management. Both children and parents/caregivers will receive the services of the A+ Asthma Rural Community health Workers ((CHWs). SHP in the intervention group will receive a six-hour asthma rural training, and services of the A plus Asthma Rural Nurse Consultants (RNCs) who have received special training to instruct SHP to manage childhood asthma and CHWs. A plus Asthma RNCs will assist with children's and parents'/caregivers' workshops and CHWs will make home visits to parents who missed workshops or to children with frequent school absences. Differences in outcome measures described in the specific aims will be evaluated between baseline and the end of the program during one school year using generalized linear modeling and extensions of analysis of covariance. The major hypothesis is that children in the intervention group will show significant improvements in their quality of life compared to those in the standard control group. The findings of this study will be important to clinicians, researchers, and health policy makers.