Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago

Abstract

Abstract Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago.

Methods: This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics.

Results: While most of the participants had uncontrolled persistent asthma, <50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n=51), the CHW arm had lower odds of having an ICS (OR=0.2; p=0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n=50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p<0.01) and 14.2% more steps correct at 12 months (p<0.01).

Conclusions: While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.

Trial registration: ClinicalTrials.gov NCT01061424 NCT01065883.

Keywords: Hispanic; behavioral intervention; community health worker; pediatric; randomized controlled trial.

Figure 1:. Consort Diagram

^aOne CHW falsified data reports resulting in no visits being offered to 7 participants in Elementary School Cohort and 2 participants in High School Cohort. One participant in the High School Cohort refused all CHW home visits. ^bNo participants withdrew from the study. All lost to follow-up either did not answer telephones/mail or refused home visits for data collection. ^cSample size too small for imputation.

Figure 2:. Primary Medication and Trigger Outcomes at 5 and 12 Months

Models are controlled for baseline value of outcome measure. P-values reflect treatment effect and are displayed when significant at the 5- or 12-month assessment respectively. *CHW Arm and Mail arm superimposed.