Community Health Worker Asthma Interventions for Children: Results From a Clinically Integrated Randomized Comparative Effectiveness Trial (2016‒2019)

Abstract

Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5‒16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention. Public Health Implications. Clinically integrated asthma CHW and AE-C services that do not provide home environmental remediation equipment may improve and sustain asthma control.

FIGURE 1—

Asthma Action at Erie CONSORT Diagram Note. AE-C = certified asthma educator; CHW = community health worker; CONSORT = Consolidated Standards of Reporting Trials. ^aTwo formal withdrawals: 1 at 12 months and 1 at 24 months.

FIGURE 2—

Adjusted Models of Asthma Control at Various Timepoints for (a) Asthma Control Test (ACT) or Childhood Asthma Control Test (c-ACT) and (b) Activity Limitation Over Past 14 Days: Cook County, IL, 2016–2018 Note. AE-C = Childhood Asthma Control Test.