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

Community health workers (CHWs) are frontline public health workers who connect immigrant communities with health care services. Although CHW asthma interventions have been shown to improve some outcomes, their ability to change medication adherence remains unclear.

Our goal was to determine if intensive asthma medication training resulted in objective improvements in asthma medication instruction abilities for immigrant Mexican CHWs.

Eleven CHWs participated in a 15-hour training course conducted in only Spanish. The course covered asthma pathophysiology, reliever and controller medications, medication technique, and self-management skills. Before and after the training, CHWs completed a written asthma knowledge test and 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. At follow-up evaluations, the CHWs described benefits and weaknesses of the training.

Before the training, the median correct medication technique scores were: MDI = 25%, spacer = 0%, and DPI = 0%. After the training, the median scores were: MDI = 69%, spacer = 64%, and DPI = 67% (p < .01). On the role plays, all CHWs were scored as "Demonstrates adequate understanding of a complicated skill" and four were "Ready for the field on a clinical trial." The CHWs described specific application of training skills during the subsequent delivery of an asthma intervention.

This training and follow-up evaluation provide objective evidence of improved asthma medication knowledge, delivery technique, and instruction abilities in immigrant Mexican CHWs. With proper training, CHWs can assist families to understand and correctly use complicated asthma medications.