A child’s asthma has a lot to do with the environment. On any given day, they spend time in multiple places that may differ considerably. While they may have no trouble controlling their asthma at home, dusty desks at school or air pollution at a park could trigger symptoms. Much has been done to address asthma factors within different environments, but researchers at Children’s Hospital of Philadelphia (CHOP) set out to examine how to integrate interventions across them.
“Children live in many different environments, so their asthma care needs to be connected if we're really going to move the needle in reducing asthma disparities,” said Tyra Bryant-Stephens, MD, medical director of the Community Asthma Prevention Program (CAPP), and chief health equity officer of the Center for Health Equity at CHOP.
Ultimately, the researchers found that using community health workers to coordinate interventions across environments results in substantially better asthma control.
Integrating asthma care across environments
The study examined community health worker’s coordinated asthma control interventions across homes, schools, and the health care system. Researchers followed more than 600 children with asthma in west Philadelphia, a traditionally underserved community. By comparing Asthma Control Questionnaire (ACQ) scores to baseline levels after 12 months, researchers were able to quantify the interventions’ effects. The study consisted of four test groups, with one cohort receiving all coordinated interventions:
- Home. Community health workers visited patient homes for educational sessions and environmental mitigation.
- School. Community health workers worked with school nurses to coordinate asthma care plans; facilitate asthma education seminars in the schools; conduct on-site environmental surveys; and help administer daily asthma medications.
- Community. The team implemented the Yes We Can Children's Asthma Partnership program, a medical and social initiative that helps children with asthma in underserved communities. They implemented Open Airways for Schools, an American Lung Association collaborative that educates and empowers children on asthma self-management.
- Health care offices. Community health workers logged notes from all interventions to align primary care providers and other specialists about patients’ asthma care. They prepped patient families on questions to ask during clinical visits or attended those meetings with them if requested.
The research spanned 2018-2022, so COVID-related school shutdowns and social distancing measures impacted the team’s findings. However, statistically significant improvements were reported across all test groups prior to the pandemic’s onset. Notably, the group receiving coordinated interventions across their various environments demonstrated an average ACQ score decrease from 1.40 to 0.18.
"Community health workers are really the key to this project. They have expertise in their community, know how to communicate, and understand the struggles."
Next steps and keys to success
The study’s findings are helping shape CHOP’s approach to asthma care. The hospital has deepened its relationships with schools, with more than 15 expressing interest in school-based therapy and medication management services. They’ve also started offering Open Airways for Schools classes in several new locations.
Perhaps the most impactful change from the study involves enhanced communication among patient families, their schools, and health care teams. Open communication around in-school medication management improves overall health, school attendance, and extracurricular participation, Bryant-Stephens said.
And while CHOP used community health workers before the research, the study’s findings underscore their importance in better asthma control.
“They have expertise in their community, know how to communicate, and understand the struggles,” Bryant-Stephens said. “Community health workers are really the key to this project.”
