Examining the community health worker model of care in pediatric asthma

PROJECT SUMMARY Community health worker (CHW) focused interventions have been found to improve pediatric asthma symptoms and reduce Medicaid costs. Pediatric asthma disproportionately affects Black and Latinx children, and children living in low-income, urban areas. Families living in urban settings experience additional stressors (e.g., neighborhood violence, increased exposure to irritants) that contribute to increased child asthma morbidity. CHWs focus on connecting care among schools, providers, and homes, and empowering families in accessing resources to overcome barriers to care. However, research is just beginning to understand how CHWs create positive change among families within low-income, urban communities. The proposed study will use a qualitative data approach and secondary data analyses of an NHLBI-funded Asthma Empowerment grant that is testing a randomized clinical trial of the community-based asthma program, RVA Breathes (PI: Everhart, U01HL138682). Participants in RVA Breathes are predominantly African American, reside in public housing, and report an income below the poverty line. This mixed-methods F31 study proposes to examine the processes by which CHWs in RVA Breathes assist families in improving their children's asthma control over an 18-month period. As a novel component, this proposal considers how CHWs and families have been affected by the COVID-19 pandemic. For this F31 study, CHW session notes (both pre/post the start of COVID-19 in mid-March 2020) from the RVA Breathes intervention will be qualitatively analyzed. Furthermore, I will conduct three focus groups (two English-speaking groups; one Spanish-speaking group) with caregivers who have completed the intervention phase of RVA Breathes, and one focus group with the RVA Breathes' CHWs. Secondary data analyses will use multi-level modeling to assess the association of barriers to care and resource engagement with asthma control over 18 months. Specific aims of this F31 are: 1) to identify barriers to care and examine engagement with CHW provided resources targeting such barriers both pre-COVID-19 and currently, 2) to examine associations between caregiver-level factors, type of CHW provided resources (e.g., asthma-specific, socially-specific), and changes in asthma control, and 3) to collaboratively develop a manual of resources for CHWs to use locally, with potential for regional dissemination. The proposed study is critical in understanding how CHWs empower families to overcome barriers to asthma care and address social determinants of health at the family level, all within the context of a pandemic. My comprehensive training plan includes training in multi-level modeling, qualitative analyses, asthma health policy, asthma medical treatment, and the CHW model of care using a carefully crafted team that I would not have access to working with without this opportunity. The proposed research and training plan are essential in my development as an independent researcher in the field of pediatric asthma disparities.