Use of Lay Health Educators to Improve Asthma Management Among African American Children: Findings from a Pilot Study in Chicago

Asthma affects 25% of children living in disadvantaged Chicago neighborhoods, a rate twice the national prevalence (12%). These children tend to rely heavily on the emergency department (ED) for asthma care and our research has shown that they are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a Lay Health Educator (LHE) model for its effectiveness in reducing asthma morbidity and improving quality of life among African American children living in disadvantaged Chicago neighborhoods. Trained LHEs from targeted communities provided individualized asthma education during 3-4 home visits over six months. The LHE also served as a liaison between the family and the medical system. Seventy children were enrolled into the pilot phase between 11/15/2004-7/15/2005, of which 96% were Medicaid insured, and 54% lived with a smoker. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Findings are suggestive of improved asthma control. Specifically, symptom frequency was reduced 2-fold and urgent health resource utilization 3-fold between the pre- and post-intervention periods. Parental Quality of Life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. Findings suggest that individualized, asthma education provided by a trained, culturally competent LHE may be effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.