Using selected health outcomes to plan asthma programs

The dramatic rise in asthma prevalence over the last few decades has caused a proliferation of community based programs employing a range of strategies to address this complex disease. Through a cooperative agreement with the Indoor Environments Division of the US Environmental Protection Agency, the Asthma Health Outcomes Project (AHOP) examined asthma programs worldwide that included an environmental component to identify types of activities offered, how programs were implemented and factors associated with success. AHOP catalogued over 500 asthma programs and gathered details about the subset of programs that reported successfully improving health outcomes. Within this subset, among published programs that used a randomized controlled trial in evaluation (n=65), bivariate relationships between programmatic factors and health outcomes were analyzed using X² statistics and Fisher's exact tests (p<0.05), and unconditional logistic regression (p<0.05). Results show that different program factors are associated with different outcomes, and programs would benefit from considering which outcomes are of greatest importance. For example, having an office located in the target community, collaborating with others, and having a component that takes place in a physician's office or clinic were associated with improved health care utilization. Tailoring the intervention based on individuals' health or educational needs, particularly based on an assessment of trigger sensitivity, increased the likelihood of improving quality of life. Qualitative responses provide additional insights into factors important to program development. Findings can be used by policy makers and program planners interested in implementing asthma intervention programs with the best chances of success.