Examining the community health worker model of care in pediatric asthma

项目总结 社区卫生工作者(CHW)的重点干预措施已被发现可改善儿童哮喘 症状和降低医疗补助费用。儿童哮喘对黑人和拉丁裔儿童的影响不成比例， 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承受着额外的压力 (例如，邻里暴力、更多地接触刺激物)导致儿童哮喘增加 发病率。CHW的重点是将学校、提供者和家庭之间的护理联系起来，并在 获取资源以克服护理障碍。然而，研究才刚刚开始了解如何 社区卫生服务在低收入城市社区的家庭中创造了积极的变化。拟议的研究将 对NHLBI资助的哮喘授权使用定性数据方法和二次数据分析 Grant正在测试社区哮喘项目RVA Breathes的随机临床试验(PI： Everhart，U01HL138682)。参加RVA呼吸的人主要是非洲裔美国人，居住在公共场合 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个月。作为一个新的组成部分，这项建议考虑了家庭和家庭如何受到影响 受新冠肺炎大流行的影响。对于这项F31研究，CHW会议注意到(在年新冠肺炎开始之前/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)，护理员有 完成RVA呼吸的干预阶段，其中一组用RVA呼吸的CHW。 二次数据分析将使用多水平建模来评估护理障碍和 与哮喘控制相关的资源投入超过18个月。F31的具体目标是：1)识别障碍 为了关注和审查与CHW的接触，提供了针对这些障碍的资源，在新冠肺炎之前 目前，2)检查照顾者级别的因素、CHW提供的资源类型之间的关联 (例如，特定于哮喘的、特定于社会的)，以及哮喘控制的变化，以及3)合作开发 供社区卫生工作者在当地使用的资源手册，有可能在区域内传播。建议的研究是 对于理解CHW如何使家庭克服哮喘护理的障碍和解决社会问题至关重要 家庭健康的决定因素，所有这些都是在大流行的背景下进行的。我的全面培训计划 包括多层次建模、定性分析、哮喘健康政策、哮喘医疗、 而CHW的护理模式使用了一个精心设计的团队，如果没有这个团队，我就无法与之共事 这个机会。建议的研究和培训计划对我作为一个独立的 研究儿童哮喘领域的差异。

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.