Comparing programs to improve asthma control and quality of life for Latino youth living in rural areas and their caregivers : the Respira Sano Study / John P. Elder.

Format:

Book

Author/Creator:

Elder, John P., author.

Language:

English

Subjects (All):

Medicine, Psychosomatic--methods.

Medicine, Psychosomatic.

Physical Description:

1 online resource (51 pages)

Other Title:

Comparing programs to improve asthma control and quality of life for Latino youth living in rural areas and their caregivers

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute, 2021.

Summary:

BACKGROUND: Asthma is a prevalent chronic disease in rural and border communities, with active asthma prevalence rates of 21% among 5- to 17-year-olds in Imperial County, California, near the border with Mexico, compared with the statewide prevalence of 12% among all California residents. Risk factors for poor asthma control include ineffective disease management in the home, school, and community; suboptimal health care; and poor air quality. Comprehensive approaches are needed that recognize these multiple risk factors and intervene to reduce them. OBJECTIVE: The Imperial County Asthma Comparative Effectiveness Research project (ie, Respira Sano [Breathe Easy]) was a multisector, multilevel intervention designed to reach rural border youth aged 6 to 17 years and their caregivers. We sought to determine whether a family intervention, a clinic intervention, or a combined approach (family plus clinic), all nested within a community intervention, would result in differential improvements in youth- and caregiver-reported quality of life (QOL) and asthma symptoms and their consequences compared with a community-only control condition. METHODS: Respira Sano was a 2 × 2 factorial study nested within a community intervention. The family intervention provided asthma education and management strategies through home visits and phone calls from community health workers over a 2-month period. The clinic intervention established an Asthma Care Model that included hiring asthma educators, training providers, and making changes to electronic health records to promote quality asthma care. The community intervention promoted awareness of air quality and management techniques through partnerships with schools and media outlets. A cohort of 400 Spanish- or English-speaking youth aged 6 to 17 years with mild to severe persistent asthma and their parent/legal guardian (ie, caregiver) agreed to participate. Youth who were patients of Clinicas de Salud del Pueblo, Inc (CDSDP) were randomly assigned to 1 of the clinic intervention conditions (clinic only or family plus clinic); those who were not patients were randomly assigned to 1 of the no-clinic intervention conditions (family only or control). All youth were randomly assigned to the family intervention or no family intervention. The primary outcomes were QOL (caregiver self-report and in a subsample of age-eligible youth [aged 9-17 years], youth self-report) and asthma symptoms and consequences (caregiver report on youth and youth self-report). Respira Sano was a partnership between academic institutions (San Diego State University and the Institute for Behavioral and Community Health), a federally qualified health center (specifically, CDSDP), a community-based organization (Comite Cívico del Valle), and Impact Assessment, Inc, an environmental public health education and consulting firm. It was conducted in Imperial County, California, between August 16, 2015, and July 15, 2017. RESULTS: We used mixed-effects models to examine the main effects of the family intervention, main effects of the clinic intervention, and their interaction. There were no significant interactions on the primary outcomes of QOL, asthma symptoms, and asthma consequences (missed school days). There was, however, a main effect of the clinic intervention such that youth who received it vs those who did not had fewer unplanned doctor visits (β = −.17; 95% CI, −0.28 to −0.05; P = .01) as reported by the caregiver. CONCLUSIONS: Multilevel, multisector interventions recognize the complexity of influences on the prevention and control of asthma. The results from Respira Sano suggest that health care-level interventions are critical to improving important expenditure-related outcomes in the affected population. LIMITATIONS: Several major limitations of the study are important to note, including the quasi-experimental study design, the reliance on self-report for assessment of change in the primary outcomes, and the lack of process evaluation data to minimize risks associated with type III error.

Notes:

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