Asthma in Children
Conditions
Brief summary
The long-term goal is to implement an evidence-based asthma intervention based on the Center for Disease Control's recommended framework (EXHALE) within Baltimore City Public Schools (BCPS). As part of a stepped wedge pragmatic trial the investigators will: 1. Evaluate the effectiveness of a tailored implementation plan of Asthma CHAMPS in 32 Baltimore city elementary schools to reduce asthma disparities. 2. Conduct a pragmatic trail using a stepped wedge design to evaluate implementation of a school and home asthma intervention program to reduce asthma-related absences, healthcare utilization and exacerbations and improve asthma control, among children enrolled in 32 Baltimore City elementary schools. 3. Use qualitative methods (observation and semi structured interviews) to obtain stakeholder feedback (parents, community health workers, school personnel and administrators) on impact of Asthma CHAMPS, identify potential refinements in intervention and implementation strategies, and evaluate impact of local adaptation and fidelity on implementation success and sustainability.
Detailed description
Implementation Aim: Evaluate the effectiveness of a tailored implementation plan of Asthma CHAMPS in 32 Baltimore city elementary schools to reduce asthma disparities. Hypothesis: The investigators hypothesize that Baltimore City schools will have greater adoption and penetration of Asthma CHAMPS (e.g. more schools participating, and more staff and family asthma education sessions), greater feasibility/acceptability (e.g. more staff participating in asthma care activities, greater staff confidence in managing asthma) and greater satisfaction and appropriateness with a tailored implementation strategy compared to wait list-control group. The long-term goal is to implement an evidence-based asthma intervention based on the Centers for Disease Control (CDC) recommended framework (EXHALE)14 within BCPS. To provide the foundation for success, the investigators will identify and engage local key stakeholders, conduct a community needs assessment to inform necessary refinement and adaptations of the interventions, and develop a tailored collaborative strategy to ensure successful implementation of an asthma intervention program. Results for this multi-phase project will identify best practices for implementation of a tailored multi-level asthma intervention program (Asthma CHAMPS: Community and Home Asthma Management Program in Schools), within Baltimore City Schools to reduce asthma disparities. Effectiveness Aim: Conduct a pragmatic trail using a stepped wedge design to evaluate implementation of a school and home asthma intervention program to reduce asthma-related absences, healthcare utilization and exacerbations and improve asthma control, among children enrolled in 32 Baltimore City elementary schools. Hypothesis: Children with asthma who attend schools engaged in Asthma CHAMPS program will have improved asthma outcomes, including improved asthma control, reduced ED visits/hospitalizations and courses of oral corticosteroids and impact (reduced asthma-related school absences). Qualitative Aim: Use qualitative methods (observation and semi structured interviews) to obtain stakeholder feedback (parents, community health workers, school personnel and administrators) on impact of Asthma CHAMPS, identify potential refinements in intervention and implementation strategies, and evaluate impact of local adaptation and fidelity on implementation success and sustainability.
Interventions
BEHAVIORALAsthma CHAMPS full program
Full program includes (1) education for staff, students, and caregivers (2) environmental education and intervention (3) asthma care coordination (4) resources
BEHAVIORALAsthma CHAMPS Wait List Control
Stepped wedge design
Sponsors
Johns Hopkins University
Baltimore City Public Schools
Baltimore City Health Department
National Heart, Lung, and Blood Institute (NHLBI)
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Adult Inclusion Criteria: * Aged 18 or older * Current caregiver of child with asthma or staff member at a Baltimore City K-8 Public School in Asthma CHAMPS
Exclusion criteria
* Unwilling to consent Children with asthma Inclusion Criteria: * Asthma diagnosis * Currently enrolled in Baltimore City K-8 Public School participating in Asthma CHAMPS
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Asthma-related absences | 4 years | Administrative data from schools on attendance for child with asthma |
| Emergency Department (ED) utilization for asthma by children | 4 years | Counts of ED visits for asthma |
| Hospitalization for asthma by children | 4 years | Counts of hospital admissions for asthma |
| Oral corticosteroid steroid prescription for asthma by children | 4 years | Counts of prescribed oral corticosteroids for asthma |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intervention penetration as assessed by counts | 4 years | Counts of asthma education sessions for family and staff |
| Acceptability of Intervention (AIM) as assessed by a 4 item questionnaire | 4 years | 4 item measure of implementation outcome often considered "leading indicator" of implementation success. Administered on a 5 point Likert scale with higher scores indicating greater agreement with specific items. |
| Intervention Appropriateness Measure (IAM) as assessed by a 4 item questionnaire | 4 years | 4 item measure of implementation outcome often considered "leading indicator" of implementation success. Administered on a 5 point Likert scale with higher scores indicating greater agreement with specific items. |
| Feasibility of Intervention (FIM) as assessed by a 4 item questionnaire | 4 years | 4 item measure of implementation outcome often considered "leading indicator" of implementation success. Administered on a 5 point Likert scale with higher scores indicating greater agreement with specific items. |
| Intervention Satisfaction as assessed by a composite measure | 4 years | Composite measure administered to staff and caregivers with items assessing asthma management motivation and confidence. Answer options are on a scale of 1-10 with higher scores generally indicating greater agreement. |
Countries
United States
Contacts
CONTACTMichelle N Eakin, PhD
CONTACTMeredith McCormack, MD MHS
PRINCIPAL_INVESTIGATORMichelle N Ealin, PhD
JHU
PRINCIPAL_INVESTIGATORMeredith McCormack, MD MHS
JHU
Outcome results
None listed