PURPOSE OF THE STUDY:
To evaluate if a multilevel home and preschool asthma educational program is more effective in improving asthma control, compared with a preschool-based program alone. Specifically, because this study was conducted within the Head Start program and targeted at an at risk population, with the study, the researchers examined if their multilevel intervention could address asthma disparities.
Eligible participants were caregivers with children aged 2 to 6 years with the confirmed physician-diagnosed of asthma who were also enrolled in one of 14 Head Start programs in Baltimore, Maryland. Participants were recruited from April 1, 2011, to November 31, 2016.
Screening forms were provided through Head Start staff, and families who gave permission were contacted by telephone to confirm eligibility and schedule the first home visit. Families were randomly assigned to either the Action for a Better Community (ABC) Plus Head Start education group or the Head Start education alone group by using a 1:1 block randomization scheme. Families were not blinded to their random assignment, but the research assistants who completed assessments were blinded and were different from the intervention staff. The ABC family intervention consisted of 4 30- to 45-minute in-person, at-home asthma management educational sessions and 3 booster calls. Assessment visits were completed by research assistants: in home visits at baseline and 6 months and telephone visits at 3, 9, and 12 months. The primary outcome was the Test for Respiratory and Asthma Control in Kids (TRACK) score to assess the degree of asthma control. Caregiver reports of emergency department visits, hospitalizations, and courses of oral corticosteroids (OCS) in the previous 3 months were collected at each assessment visit. Caregiver health–related quality of life was measured by using the Pediatric Asthma Caregiver’s Quality of Life Questionnaire.
A total of 398 families were randomly assigned to either the ABC Plus Head Start educational program (n = 199) or Head Start educational program alone (n = 199). Most participants were Black (379 [95.2%]) and had a family income of less than $40 000 a year (357 [89.7%]). There were no significant group differences on any demographic characteristic. Of those in the intervention group, 144 (72.4%) completed at least 1 home education session, 69 (34.7%) completed all 4 home visits, and 71 (35.8%) completed all the booster telephone calls after the 3-, 6-, and 9-month follow-up surveys. Although there was an overall improvement in TRACK total scores for both groups over time (β = 3.00; 95% confidence interval (CI): 2.47 to 3.54; P < .001), those in the intervention group had clinically significant score differences at 3 months, compared with that of those in the control group (β = 6.26; 95% CI: 1.77 to 10.75; P < .001). There was no significant difference in TRACK scores among groups at months 6, 9, and 12. Participants in the intervention group were significantly less likely to have OCS use at 9 months (β = −0.61; 95% CI: −1.13 to −0.09; P = .02) and hospitalization during the 12-month follow-up period (odds ratio: 0.36; 95% CI: 0.21 to 0.61; P < .001). There was a significant improvement in asthma-related quality of life at 12 months for both groups (β = 0.28; 95% CI: 0.19 to 0.38; P < .001) but no difference between intervention and control groups.
The multilevel asthma education intervention decreased several measures including asthma symptom scores at 3 months, OCS use at 9 months, and decreased hospitalizations during the 12-month follow-up period.
This educational program revealed modest improvements in asthma control and health care use. It is not entirely clear why TRACK scores only revealed differences at 3 months and OCS use at 9 months; however, the decrease in asthma hospitalization during 12-month follow-up indicates a true significant effect, especially because preschool-aged children have the highest risk for use of health care services. However, it should be noted that health care resources for asthma outcomes was collected via caregiver report and not verified by using medical records, possibly leading to bias. Overall, with this study, the authors highlight how implementation of an asthma educational program by using a community partner was an effective strategy for targeting a population disproportionately affected by health disparities.