Intervention for Improving Asthma Care for Minority Children in Head Start

BACKGROUND:

Asthma-related morbidity and mortality are disproportionately high among low-income African
American children. The effects of asthma are particularly harsh in very young children and
their families, resulting in high rates of emergency department care, hospitalization,
decreased quality of life, and the risk of fatal asthma. Research suggests that the
contributing factors to this high morbidity include under-use of asthma primary preventive
care, sub-optimal medical management, and inappropriate asthma management behaviors. Despite
the importance of early and regular asthma preventive care for children, this goal has proved
elusive. Head Start programs offer an ideal venue for accessing high-risk, low-income
preschool children and improving asthma morbidity. The study will test the hypothesis that
removing barriers to preventive asthma care and facilitating communication between parents
and primary care providers (PCP) are necessary prerequisites to optimally influence
caregiver's asthma management practices. The study will remove barriers by the use of
Breathmobile, a community-based service that is specifically designed to deliver asthma
screening and special consultation directly to families and children in high-risk
neighborhoods. In addition, the study will evaluate a caregiver/PCP communication
intervention designed to facilitate communication between parents and PCPs about a child's
asthma severity and recommended therapy.

DESIGN NARRATIVE:

This two times two modified factorial study design will compare the following in their
effectiveness in reducing asthma morbidity and improving asthma management: a Breathmobile
intervention combined with a Facilitated Asthma Communication intervention (FACI); a FACI
alone; the Breathmobile intervention alone; or a control group. A total of 360 Head Start
students ages 2 to 6 with symptomatic doctor-diagnosed asthma will be recruited. The primary
study outcome measure will be the number of symptom-free days over a period of 12 months.
Secondary outcomes include health care utilization (i.e., emergency department visits,
hospitalizations, and primary care visits), asthma medications, parent asthma-related quality
of life, parent asthma management practices, and cost-effectiveness. The study will test the
hypothesis that a FACI combined with the Breathmobile intervention will be the most effective
in improving parent and PCP management of the child's asthma and in reducing asthma
morbidity.

Inclusion Criteria:

- Diagnosis of asthma or reactive airway disease (RAD) OR

- Experienced asthma symptoms within 1 month prior to study entry

- Treated for asthma in the emergency department within 6 months prior to study entry

- Asthma symptoms include day or nighttime wheezing, shortness of breath and cough, or
use of rescue medicine (e.g., albuterol or ventolin)

Exclusion Criteria:

- Currently participating in another asthma education research study