A Randomized Controlled Trial of the Effectiveness of Parent Mentors in Improving Asthma Outcomes in Minority Children

Asthma disproportionately affects minorities, but few studies have evaluated interventions to improve asthma outcomes in minority children.

Objective: To determine whether Parent Mentors (PMs) are more effective than traditional asthma care in improving minority children's asthma outcomes.

Methods: This randomized, controlled, single-blinded trial recruited participants from a consecutive series of minority children 2–18 years old seen for asthma in 4 urban EDs or hospitalized at a children's hospital from 2004-07. Participants were randomized to the PM intervention or control group (traditional asthma care). Intervention families were paired with PMs, experienced minority parents of asthmatic children. Latino PMs were bilingual. PMs received 2.5 days of training on childhood asthma and assisting families with unmet needs for insurance, housing, food, and other issues. PMs met monthly with up to 10 asthmatic children and their families at community sites, phoned parents monthly, and made 2 home visits. 11 outcomes were monitored for 1 year by blinded staff. Stratified analyses examined outcomes for high participants (HPs) in the intervention (attending ≥25% of monthly community meetings and completing ≥½ of monthly PM phone interactions).

Results: 220 of 648 children assessed met study criteria and were randomized to PMs (N=112) or the control group (N=108); there were no baseline intergroup differences. PM children (vs. controls) had significantly lower adjusted odds of asthma exacerbations (-14%; p=.003), higher parental satisfaction with care scores (mean difference=2.25), and higher quality of life (QOL) in those with less severe asthma (p=.02). HPs (vs. low participants) experienced significantly fewer asthma exacerbations (-20%; p=.003), missed school days (-13%; p=.02), missed parental work days (-20%; p=.01), wheezing (-21%; p=.02) and chest tightness (-14%; p<.05), but had higher parental satisfaction scores (mean difference=2.85), and higher QOL in those with less severe asthma (p=.02). Children with lower severity asthma benefited most from PMs, experiencing significantly fewer episodes of wheezing, cough, dyspnea, tachypnea, and chest tightness, and 2 non-significant trends: lower rates of ED visits (13/100 vs. 31/100 in controls; P=.07) and hospitalizations (6/100 vs. 11/100 ; P=.11). The average cost to run the PM program was $51.79 per intervention family per month, and cost savings were noted in use of health services and missed parental work.

Conclusions: PMs are more effective than traditional asthma care in improving several asthma outcomes in minority children, especially for those with high intervention participation and low asthma severity. PMs may hold promise for reducing disparities in asthma and other chronic diseases.