Implementation of an intervention to improve the adoption of asthma self-management practices in Peru: Asthma
Elisa D Romani1,2, Trishul Siddharthan2,3, Nair Lovatón4
1Biomedical Research Unit, Asociación Benéfica PRISMA, Carlos González 251, San Miguel, Lima, Peru.
Insights
A new asthma self-management intervention in Peru improved care for children. This locally tailored program addresses the asthma treatment gap in low-income communities, enhancing health outcomes.
Area of Science:
- Pediatric pulmonology
- Global health
- Implementation science
Background:
- Asthma is a leading chronic childhood illness globally, disproportionately affecting low- and middle-income countries (LMICs).
- Despite existing guidelines, guideline-based asthma care is underutilized in both high-income and LMIC settings.
- In Lima, Peru, less than 5% of children in low-resource communities receive guideline-based asthma therapies, highlighting a significant treatment gap.
Purpose of the Study:
- To develop and evaluate a locally adapted intervention package to enhance asthma self-management and healthcare service utilization among children in Lima Norte, Peru.
- To address the critical need for effective, context-specific asthma management strategies in LMICs.
Main Methods:
- An individually randomized implementation-effectiveness hybrid trial involving 110 children (aged 5-17) with asthma and their caregivers.
- The intervention utilized a theory-based framework (Capability, Opportunity, Motivation - Behavior) and formative research.
- Outcomes assessed included asthma control, healthcare utilization, medication adherence, quality of life, and intervention feasibility over six months.
Main Results:
- The study is designed to evaluate the effectiveness of a supported self-management intervention compared to standard care plus asthma education.
- Key metrics include asthma control (Asthma Control Test), healthcare utilization, medication adherence (Adherence to Refills and Medications Scale), and quality of life (Pediatric Asthma Quality of Life Questionnaire and Pediatric Asthma Caregiver's Quality of Life Questionnaire).
Conclusions:
- This study aims to disseminate locally appropriate asthma management strategies in LMIC settings.
- Findings will contribute to understanding theory-based, contextually grounded approaches for developing and evaluating asthma interventions.
- The research has the potential to inform scalable solutions for asthma management in resource-limited environments.
Introduction:
Asthma is the most common chronic disease among children worldwide, with 80% of asthma-related deaths occurring in low- and middle-income countries (LMICs). While evidence-based guidelines exist for asthma treatment and management, adoption of guideline-based practices is low in high-income country and LMIC settings alike. While asthma prevalence among children and adolescents in Lima, Peru is in the range of 13%-19.6%, our data suggest that < 5% of children in low-resource communities are currently taking guideline-based therapies. There is an urgent need for effective, locally tailored solutions to address the asthma treatment gap in low-income communities in Peru.
Methods:
This study aims to develop and test a locally adapted intervention package to improve adoption of self-management practices and utilization of preventive health services for asthma among children in Lima Norte. The intervention package was designed using a systematic, theory-based framework (Capability, Opportunity, Motivation - Behavior Framework) and is rooted in a multi-phased formative research approach. The main study design is an individually randomized implementation-effectiveness hybrid trial enrolling 110 children aged 5-17 years with asthma and their caregivers. Families allocated to the treatment group receive the supported self-management intervention package, while families allocated to the control group receive the standard of care plus asthma education. We will follow participants monthly for six months and evaluate asthma control (Asthma Control Test), healthcare utilization, and medication adherence (Adherence to Refills and Medications Scale). Disease-specific quality of life for children (Pediatric Asthma Quality of Life Questionnaire) and caregivers (Pediatric Asthma Caregiver's Quality of Life Questionnaire) will be evaluated at baseline, 3 months, and 6 months. We will also evaluate acceptability, feasibility, and fidelity of the intervention using mixed methods approaches.
Discussion:
The long-term goal of this study is to disseminate locally appropriate asthma management strategies in LMIC settings. This study will contribute to the body of knowledge surrounding approaches for developing and evaluating intervention strategies for asthma using systematic, theory-based approaches grounded in local context. Such strategies have the potential to inform the development and adaptation of appropriate and scalable solutions for asthma management in LMIC settings.
Trial Registration:
ClinicalTrials.gov, NCT03986177. Registered on 14 June 2019.
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