Evaluation of an asthma medication training program for Mexican community health workers

While community health worker (CHW) asthma interventions have been shown to reduce environmental asthma triggers and improve clinical outcomes, they have not improved medication usage. Our objective was to test if an intensive asthma training program focusing on self-management skills would improve asthma medication instruction abilities for CHWs.

Eleven CHWs participated in a 15-hour training course. The course covered asthma pathophysiology, reliever and controller medications, medication technique, and self-management skills. The CHWs were all women from Mexico. They spoke mainly Spanish and had 6-17 years of formal education. Before and after the training, CHWs completed a written asthma knowledge test. CHWs were tested on medication delivery technique using a demonstrator metered dose inhaler (MDI), spacer, and dry powder inhaler (DPI). After the training, CHWs performed a standardized role play to assess their ability to deliver medication instruction. They also completed a training evaluation questionnaire.

Knowledge improved significantly post-training (mean: pre=65%, post=81%, p<0.01). Before training, the median correct medication technique scores were: MDI=25%, spacer=0%, DPI=0%. Post-training, the median scores were: MDI=79%, spacer=71%, DPI=78% (p<0.01). On the role-plays, all promotoras were scored as “Demonstrates adequate understanding of a complicated skill” and 4 additionally were “Ready for the field on a clinical trial.”

This training improved asthma medication knowledge and delivery technique instruction abilities for Mexican CHWs. These CHWs will now begin the ultimate test of this training as they deliver an asthma medication intervention in the field. The CHWs will speak about which aspects of the training were unique and most useful.