Culturally appropriate delivery of asthma management education via Community Health Workers: Evaluation of a Chicago based intervention

Asthma affects 25% of children living in disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). In response to this injustice, the Sinai Urban Health Institute and Sinai Children's Hospital developed and tested an innovative Community Health Worker (CHW) approach to improving asthma outcomes among African American and Latino children with severe asthma living in Chicago. The model utilizes CHWs recruited from targeted communities to deliver case-specific asthma education via three home visits over six months. The goal was to improve asthma self-management, thereby reducing asthma symptoms and health resource utilization, and improving quality of life. The CHW also served as a liaison between the family and the medical system. Data on 141 (of 236 enrolled) children who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Findings demonstrated significantly improved asthma control. Specifically, symptom frequency was reduced by 63% and urgent health resource utilization (sum of emergency department visits, hospitalizations, urgent clinic visits) was reduced by 58% between the pre- and post- intervention periods. Parental Quality of Life also improved by both a clinically and statistically significant level. Other important outcomes included improved asthma knowledge, decreased exposure to asthma triggers, and improved medical management. In addition given the degree of change in asthma morbidity and the low cost of the program, the intervention is cost effective. Findings suggest that a CHW model is an effective means of delivering culturally appropriate asthma education to children and their families living in disadvantaged urban communities.