Improving asthma self-efficacy: developing and testing a pilot community-based asthma intervention for African American adults

Abstract

Background: Low-income African American adults in Chicago have disproportionately high asthma morbidity and mortality rates. Interventions that improve asthma self-efficacy for appropriate self-management behaviors might ultimately improve asthma control in this population.

Objective: We sought to pilot test an intervention to improve asthma self-efficacy for appropriate self-management behaviors.

Methods: Participants for this trial were recruited through 2 primary care clinics located in the largest African American community in Chicago. Participants were then randomized into one of 2 groups. The control group received mailed asthma education materials. The intervention group was offered 4 group sessions led by a community social worker and 6 home visits by community health workers. Telephone interviews were conducted at baseline (before intervention), 3 months (after intervention), and 6 months (maintenance).

Results: The 42 participants were predominantly African American and low income and had poorly controlled persistent asthma. The intervention group had significantly higher asthma self-efficacy at 3 months (P < .001) after the completion of the intervention. Asthma action plans were more common in the intervention group at 3 months (P = .06). At 6 months, the intervention group had improved asthma quality of life (P = .002) and improved coping (P = .01) compared with control subjects. Trends in behavioral and clinical outcomes favored the intervention group but were not statistically significant.

Conclusions: This community-based asthma intervention improved asthma self-efficacy, self-perceived coping skills, and asthma quality of life for low-income African American adults. Larger trials are needed to test the efficacy of this intervention to reduce asthma morbidity in similar high-risk populations.

Figure. Asthma self-efficacy total and dimension scores at baseline, intervention completion (3 months), and follow-up (6 months)

Notes: Self-efficacy scores range from 1-5; higher is better. Baseline scores are adjusted for propensity score. 3 and 6 month scores are adjusted for baseline score and propensity score. * = P < 0.01, † = P < 0.05