New approaches for CHW-led asthma education in subsidized NYC preschools: Lessons learned from the Inspire Program

Asthma is a leading cause of hospitalizations among preschool children in underserved neighborhoods of New York City (NYC). As part of a larger citywide intervention study, community health workers (CHWs) offered individualized bilingual (English, Spanish) asthma education sessions to 49 parents of asthmatic children enrolled in subsidized preschools in East Harlem and the South Bronx, NYC from 2004-2006. An average of three education sessions lasting 20 - 30 minutes each were conducted over three months at the preschool or the parent's home. The Inspire program includes 9 educational modules covering overuse of quick-relief medications, underuse of controller medications, and Asthma Action Plans (AAPs). There was a significant increase in adherence to inhaled corticosteroids following program completion. Challenges for the CHWs included difficulties in locating and engaging parents, determining how much clinical detail to discuss, and difficulties in prioritizing education focused on medical management skills over other important socio-economic issues that affected the parent's ability to manage asthma. Efficient use of limited parental time, tailoring education to parental needs, promoting parent-provider partnerships, and utilizing clear and simple messages were key strategies used to overcome challenges. Other tactics included the ability of the CHW to make home visits and be available at the preschool at drop-off and pick-up times. The Inspire program appears to be appropriate for use in subsidized preschools to help parents of asthmatic children improve medical management. This model of education delivery may be replicated by CHWs in other preschools or used to address other health issues.