Examining the community health worker model of care in pediatric asthma

项目摘要 社区卫生工作者（CHW）的重点干预措施已被发现，以改善儿童哮喘 症状和减少医疗费用。儿童哮喘不成比例地影响黑人和拉丁裔儿童， 以及生活在低收入城市地区的儿童。生活在城市环境中的家庭会经历更多的压力 (e.g.,邻里暴力，增加接触刺激物），导致儿童哮喘增加 发病率社区卫生工作者专注于将学校、提供者和家庭之间的护理联系起来， 获取资源，以克服护理障碍。然而，研究刚刚开始了解如何 社区卫生工作者在低收入城市社区的家庭中创造了积极的变化。拟定的研究将 使用NHLBI资助的哮喘授权的定性数据方法和二级数据分析 该基金正在测试一项基于社区的哮喘项目的随机临床试验，RVA呼吸（PI： Everhart，U01HL138682）。RVA呼吸的参与者主要是非洲裔美国人，居住在公共场所， 住房，并报告收入低于贫困线。这项混合方法的F31研究建议检查 RVA呼吸中的CHW帮助家庭改善儿童哮喘控制的过程， 18-月期间。作为一个新的组成部分，这项建议考虑了社区卫生工作者和家庭如何受到影响， 受到COVID-19大流行的影响。对于这项F31研究，CHW会议注意到（在COVID-19开始之前/之后， 2020年3月中旬）将对RVA呼吸干预进行定性分析。此外，我将进行 三个焦点小组（两个讲英语的小组;一个讲西班牙语的小组）， 完成了RVA呼吸的干预阶段，并与RVA呼吸的CHW的一个焦点小组。 二级数据分析将使用多层次建模来评估护理障碍与 在18个月的哮喘控制中投入资源。F31的具体目标是：1）确定障碍 关心和检查与CHW的合作，在COVID-19之前提供针对此类障碍的资源， 目前，2）检查各级因素之间的关联，CHW提供的资源类型 (e.g.,哮喘特异性，社会特异性），以及哮喘控制的变化，以及3）合作开发一种 社区卫生工作者在当地使用的资源手册，有可能在区域传播。拟定研究 关键在于了解CHW如何使家庭能够克服哮喘护理的障碍并解决社会问题， 家庭一级的健康决定因素，所有这些都是在大流行病的背景下进行的。我的综合训练计划 包括多层次建模、定性分析、哮喘健康政策、哮喘医疗等方面的培训 和CHW模式的护理使用一个精心制作的团队，我不会有机会与没有 这个机会建议的研究和培训计划是必不可少的，在我的发展作为一个独立的 儿科哮喘差异领域的研究者。

PROJECT SUMMARY Community health worker (CHW) focused interventions have been found to improve pediatric asthma symptoms and reduce Medicaid costs. Pediatric asthma disproportionately affects Black and Latinx children, and children living in low-income, urban areas. Families living in urban settings experience additional stressors (e.g., neighborhood violence, increased exposure to irritants) that contribute to increased child asthma morbidity. CHWs focus on connecting care among schools, providers, and homes, and empowering families in accessing resources to overcome barriers to care. However, research is just beginning to understand how CHWs create positive change among families within low-income, urban communities. The proposed study will use a qualitative data approach and secondary data analyses of an NHLBI-funded Asthma Empowerment grant that is testing a randomized clinical trial of the community-based asthma program, RVA Breathes (PI: Everhart, U01HL138682). Participants in RVA Breathes are predominantly African American, reside in public housing, and report an income below the poverty line. This mixed-methods F31 study proposes to examine the processes by which CHWs in RVA Breathes assist families in improving their children's asthma control over an 18-month period. As a novel component, this proposal considers how CHWs and families have been affected by the COVID-19 pandemic. For this F31 study, CHW session notes (both pre/post the start of COVID-19 in mid-March 2020) from the RVA Breathes intervention will be qualitatively analyzed. Furthermore, I will conduct three focus groups (two English-speaking groups; one Spanish-speaking group) with caregivers who have completed the intervention phase of RVA Breathes, and one focus group with the RVA Breathes' CHWs. Secondary data analyses will use multi-level modeling to assess the association of barriers to care and resource engagement with asthma control over 18 months. Specific aims of this F31 are: 1) to identify barriers to care and examine engagement with CHW provided resources targeting such barriers both pre-COVID-19 and currently, 2) to examine associations between caregiver-level factors, type of CHW provided resources (e.g., asthma-specific, socially-specific), and changes in asthma control, and 3) to collaboratively develop a manual of resources for CHWs to use locally, with potential for regional dissemination. The proposed study is critical in understanding how CHWs empower families to overcome barriers to asthma care and address social determinants of health at the family level, all within the context of a pandemic. My comprehensive training plan includes training in multi-level modeling, qualitative analyses, asthma health policy, asthma medical treatment, and the CHW model of care using a carefully crafted team that I would not have access to working with without this opportunity. The proposed research and training plan are essential in my development as an independent researcher in the field of pediatric asthma disparities.