1
|
Morales-Torres L, Vélez-Maldonado DA, Rosario-Maldonado FJ, Aguirre-Hernández JM, Motta-Pagán JL, Rodríguez-Torruella D, Castro-Figueroa E, Ramos-Lucca A, Rivera-Mateo E, Marzán-Rodríguez M, Jiménez-Chávez J. Empowering Underserved Communities in Southern Puerto Rico: A Formal Training Program in Community Health Promotion. J Community Health 2024:10.1007/s10900-024-01346-5. [PMID: 38575835 DOI: 10.1007/s10900-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
Community health promotion offers a potential solution to persistent healthcare challenges, with community health workers playing a pivotal role. The Community Training Institute for Health Disparities (CTIHD) implemented a problem-solving curriculum in Community Health Promotion, integrating a competency-based learning model through two courses: Introduction to Community Health Promotion and Design of an Action Plan for the Promotion of Community Health. Each course comprised ten three-hour sessions, featuring pre/post-tests, evaluations, and a cognitive debriefing. Knowledge change was assessed using pre/post-test scores among 27 community leaders from southern Puerto Rico. Cohort 1 and Cohort 2 demonstrated an overall retention rate of 62.6% and 96.7%, respectively. Although differences in knowledge gained between cohorts and courses weren't statistically significant, a trend toward increased knowledge was noted. Cohort 1 experienced a 22% knowledge increase in Course 1 and a 24% increase in Course 2. Cohort 2 demonstrated a 41% knowledge increase in Course 1 and a 25% increase in Course 2. The CTIHD's Community Health Promotion Program has made significant strides in elevating awareness and knowledge, marking a positive step toward reducing health disparities and fostering healthier, empowered communities in southern Puerto Rico.
Collapse
Affiliation(s)
- Luisa Morales-Torres
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
| | - David A Vélez-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Fernando J Rosario-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jeannie M Aguirre-Hernández
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jorge L Motta-Pagán
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | | | - Eida Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Axel Ramos-Lucca
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Elizabeth Rivera-Mateo
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Melissa Marzán-Rodríguez
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Julio Jiménez-Chávez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| |
Collapse
|
2
|
Kasten-Arias C, Hodes T, Marino M, Kaufmann J, Lucas JA, Estela Vasquez Guzman C, Giebultowicz S, Chan B, Heintzman J. Healthcare utilization for asthma exacerbation among children of migrant and seasonal farmworkers. Prev Med Rep 2024; 38:102598. [PMID: 38283959 PMCID: PMC10821615 DOI: 10.1016/j.pmedr.2024.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Abstract
Latino children of Migrant and Seasonal Farmworkers (MSFWs) with asthma are at risk for poor health outcomes due to medical access barriers. We compared differences in acute care utilization for asthma exacerbations among migrant and non-migrant Latino and non-Hispanic white (NHW) children at U.S. community health centers. A retrospective observational study utilizing electronic health record data from the ADVANCE Clinical Research Network of United States community health centers included 13,423 children ages 3-17 with a primary care visit between 2005 and 2017 from eight states. Emergency department (ED) and hospitalization data came from Oregon Medicaid claims. Outcomes included acute clinic visits, ED visits, and hospitalizations for asthma exacerbation. Regression analyses adjusted for patient-level covariates. Latino children had higher odds of acute clinic visits for asthma exacerbation compared to NHW children (MSFW odds ratio [OR] = 1.17, 95 % CI = 1.03-1.33; without migrant status OR = 1.13, 95 % CI = 1.03-1.23). MSFW children using Oregon Medicaid had fewer ED visits (rate ratio [RR] = 0.72, 95 % CI = 0.52-0.99) and hospitalizations (RR = 0.47, 95 % CI = 0.26-0.86) compared to NHW children. Increased community health center visits may help mitigate disparities in acute asthma care for MSFW children.
Collapse
Affiliation(s)
| | - Tahlia Hodes
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Jorge Kaufmann
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Jennifer A. Lucas
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | | | | | - Brian Chan
- OCHIN, Inc. Portland, OR, USA
- Oregon Health & Science University, Department of Medicine, Division of General Internal Medicine & Geriatrics, Portland OR, USA
| | - John Heintzman
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
- OCHIN, Inc. Portland, OR, USA
| |
Collapse
|
3
|
Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
Collapse
Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
4
|
Martin MA, Avenetti D, Lee HH, Nordgren R, Berbaum ML, Edomwande Y, Cui L, Sandoval A. Community health worker intervention to improve tooth brushing in young children: Results from a cluster randomized controlled trial. Community Dent Oral Epidemiol 2023; 51:503-511. [PMID: 35766288 PMCID: PMC9797618 DOI: 10.1111/cdoe.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Coordinated Oral health Promotion (CO-OP) Chicago is a cluster randomized controlled trial testing the efficacy of a community health worker (CHW) intervention to improve tooth brushing in low-income children. METHODS Four hundred twenty children under 3 years old (mean 21.5 months) were recruited from 20 sites in or near Chicago, IL. Children were identified mainly as Black race (41.9%) or Hispanic ethnicity (53.8%) and most (85.2%) had Medicaid. Intervention families were offered four CHW home visits over 1 year. Brushing frequency was self-reported. Plaque score was determined from images collected in homes using disclosing solution. Analyses used GEE logistic models with variable selection at p < .05. RESULTS At enrolment, 45.0% of families reported twice a day or more child brushing frequency, and child plaque scores were poor (mean of 1.9, SD: 0.6). Data were obtained from 87.1% of children at 6 months and 86.2% at 12 months. In the CHW intervention arm (10 sites, N = 211), 23.7% received 4 visits, 12.8% 3 visits, 21.3% 2 visits, 23.2% 1 visit and 19% no visits from CHWs. No intervention effect was seen for brushing frequency or plaque score. Child brushing frequency improvement over time was associated with a range of child and caregiver factors. The only factor associated with a change in plaque score over time was parent involvement in brushing. CONCLUSIONS Oral-health-specific CHW services were not associated with improved brushing behaviours in these young children. However, caregiver involvement with brushing supported more quality brushing. More robust interventions are needed to support families during this critical developmental period.
Collapse
Affiliation(s)
| | | | - Helen H Lee
- University of Illinois Chicago, Chicago, Illinois, USA
| | | | | | | | - Liyong Cui
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Anna Sandoval
- University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
5
|
Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
Collapse
Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
| |
Collapse
|
6
|
Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1162-1168.e7. [PMID: 36716996 DOI: 10.1016/j.jaip.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prevalence of pediatric food allergy (FA) has increased in the past 2 decades. The previous literature suggests that FA presents burdens, both economically and psychosocially, to children and their caregivers, especially families in lower-income strata. Using data from a previously published needs assessment, the Food Allergy Management in Low-Income Youth study, the FA Passport and Workbook tools were developed to address identified needs. OBJECTIVE This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. METHODS Families insured through Illinois Medicaid were recruited from two Chicago-based allergy clinics. Caregivers of children with FA completed a pretest evaluating knowledge, attitudes, beliefs, and practices regarding FA management. A clinician guided caregivers through the FA Passport. The caregivers then completed a posttest immediately afterward and again 3 months later. Changes were evaluated from baseline responses and direct feedback was elicited about the tool. RESULTS The FA Passport successfully improved caregiver-reported confidence with epinephrine autoinjector use (from 69% to 93%), caregiver anaphylaxis recognition (from 66% to 73%), and reported quality of life, and it nearly doubled caregiver comfort regarding leaving the child in the care of others (from 40% to 75.7%). Caregivers rated the FA Passport tool as extremely helpful overall (9.4 out of 10). CONCLUSIONS The FA Passport is a novel FA clinical support tool that addresses barriers to proper FA management described in previous studies. It proved effective at improving caregiver comfort with regarding leaving the food-allergic children with other caregivers, increasing FA knowledge, and improving the quality of life in families affected by FA.
Collapse
|
7
|
Pappalardo AA, Martin MA, Weinstein S, Pugach O, Mosnaim GS. Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3186-3193. [PMID: 36058514 PMCID: PMC10091238 DOI: 10.1016/j.jaip.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.
Collapse
Affiliation(s)
- Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago of Medicine, Chicago, Ill.
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Oksana Pugach
- Department of Biostatistics, Corevitas, LLC, Waltham, Mass
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
| |
Collapse
|
8
|
Gill I, Shah A, Lee EK, Sommer R, Ross K, Bole A, Freedman D. Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review. Pediatrics 2022; 150:189494. [PMID: 36102121 DOI: 10.1542/peds.2021-054825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED A systematic review of interventions in community environments found significant reductions in childhood asthma exacerbations leading to emergency department visits and hospitalizations. BACKGROUND AND OBJECTIVES Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. METHODS Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). RESULTS Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. CONCLUSIONS Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.
Collapse
Affiliation(s)
- India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Aashna Shah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rachael Sommer
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Kristie Ross
- Division of Pediatric Pulmonology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aparna Bole
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| |
Collapse
|
9
|
McClellan SP, Boyd TW, Hendrix J, Peña K, Swider SM, Martin MA, Rothschild SK. Behind Closed Doors: A Thematic Analysis of Diabetes Community Health Worker Home Visit Content. FAMILY & COMMUNITY HEALTH 2022; 45:299-307. [PMID: 35985028 PMCID: PMC9394926 DOI: 10.1097/fch.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present work studies how community health workers (CHWs) perform the role of educator and how this relates to the implementation of other CHW roles, skills, and qualities. Prior studies on this topic have relied on interviews or focus groups rather than analysis of CHW interactions. We conducted a thematic analysis of 24 transcripts of conversations occurring between CHWs and participants during home visits as part of the Mexican American Trial of Community Health Workers, a randomized controlled trial that improved clinical outcomes among low-income Mexican American adults with type 2 diabetes. Three themes describing interactions related to diabetes self-management education accounted for about half of encounter content. The other half of encounter content was dedicated to interactions not explicitly related to diabetes described by 4 subthemes. In a successful CHW intervention, focused educational content was balanced with other interactions. Interactions not explicitly related to diabetes may have provided space for the implementation of core CHW roles, skills, and qualities other than educator, particularly those related to relationship building. It is important that interventions provide CHWs with sufficient time and flexibility to develop strong relationships with participants.
Collapse
Affiliation(s)
- Sean P. McClellan
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Tyler W. Boyd
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | | | - Kryztal Peña
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan M. Swider
- Department of Community Systems and Mental Health Nursing, Rush College of Nursing, Chicago, IL, USA
| | - Molly A. Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Steven K. Rothschild
- Departments of Family Medicine and Preventative Medicine, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
10
|
Pappalardo AA, Wang T, Martin MA. CHECK: Multi-level Real-World Pediatric Asthma Care Coordination: Results and Lessons Learned. J Asthma 2022; 60:1061-1071. [PMID: 36151882 DOI: 10.1080/02770903.2022.2129063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Because asthma health disparities in children remain common, innovative approaches to obtain asthma health equity are essential. Comprehensive care coordination programs may address the social determinants of health that influence these disparities. This analysis aims to ascertain if receipt of Coordination of Healthcare for Complex Kids (CHECK) program services was associated with changes in school absence, cost, healthcare utilization, and controller prescription in children with asthma. METHODS The CHECK program ran from December 1st, 2014 through August 31st, 2017. Engagement with Community Health Workers (CHW) was rolling and targeted based on risk level (low, medium or high determined by healthcare utilization). This analysis included school-aged children with asthma (n = 2,629) and sufficient Chicago Public Schools attendance data (n = 430). RESULTS Children engaged in CHECK were more likely to be female (p = 0.046) and to identify as Black and/or Hispanic/Latino than enrolled-only children. School absence was not different between the groups. Average total cost for engaged children was 21.3% more than enrolled-only children the first year (p = 0.027) but did not differ by the second year (p = 0.948). At baseline, 68.1% of the cohort had at least one ED visit 12-months prior to CHECK, this reduced to 49.5% post-1 and 41.9% post-2. Engaged children were 21% more likely to visit an ED (p = 0.010) and 40% more likely to have a controller. CONCLUSIONS CHECK program receipt was associated with reduced costs and improved healthcare utilization, and controller prescriptions. School attendance did not change. The CHECK model offers potential pathways to support low-income children with asthma.
Collapse
Affiliation(s)
- A A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - T Wang
- Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
| | - M A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
11
|
Martin MA. Children With Uncontrolled Asthma. Am J Public Health 2022; 112:e4. [PMID: 35319924 PMCID: PMC8961853 DOI: 10.2105/ajph.2022.306715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Molly A Martin
- Molly A. Martin is with the Department of Pediatrics, College of Medicine, University of Illinois, Chicago
| |
Collapse
|
12
|
Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Orozco K, Pappalardo AA, Martin MA. Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma. J Pediatr Psychol 2021; 46:673-687. [PMID: 33616185 PMCID: PMC8291673 DOI: 10.1093/jpepsy/jsab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. METHODS Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. RESULTS For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CONCLUSIONS CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.
Collapse
Affiliation(s)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Giselle S Mosnaim
- Department of Allergy, Immunology & Asthma, NorthShore University Health System
| | - Kimberly Orozco
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago
- Department of Medicine, University of Illinois at Chicago
| | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Pediatrics, University of Illinois at Chicago
| |
Collapse
|