Design of a community-based, Hybrid Type II effectiveness-implementation asthma intervention study: The Rhode Island
Grace K Cushman1, Daphne Koinis-Mitchell2, Miosotis Alsina3
1Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA.
Insights
The Rhode Island Asthma Integrated Response (RI-AIR) program reduced pediatric asthma disparities. This intervention improved asthma care by providing tailored, multi-level support to children and families, addressing critical gaps in management.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Health
Background:
- Pediatric asthma disproportionately affects Black and Latino children, highlighting existing racial and ethnic inequities in care.
- Gaps in current pediatric asthma management contribute to these disparities.
- The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address these limitations.
Purpose of the Study:
- To evaluate the effectiveness of the RI-AIR program on individual and community-level outcomes.
- To assess the implementation strategies used to increase the uptake of the RI-AIR program.
- To outline the design and methods for implementing RI-AIR in a hybrid trial.
Main Methods:
- Geospatial mapping identified high asthma-urgency areas in Providence, R.I.
- Eligible children (2-12 years) received school- and/or home-based interventions based on asthma control.
- Interventions included education, environmental assessments, and trigger remediation, with strategies like engaging school nurses and families.
Main Results:
- 6420 children were screened, 811 were eligible, and 433 were enrolled between November 2018 and December 2021.
- The study utilized a Hybrid Type II effectiveness-implementation trial design.
- Data collection occurred over a defined period to assess intervention impact.
Conclusions:
- Effective pediatric asthma interventions are crucial for reducing health inequities.
- The RI-AIR program demonstrates a successful multi-level approach to improving pediatric chronic disease outcomes.
- This study provides a model for addressing disparities in pediatric chronic disease management.
Background:
Pediatric asthma is among the most common health conditions and disproportionately impacts Black and Latino children. Gaps in asthma care exist and may contribute to racial and ethnic inequities. The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address current limitations in care. The aims of the RI-AIR Hybrid Type II effectiveness-implementation trial were to: a) simultaneously evaluate the effectiveness of RI-AIR on individual-level and community-level outcomes; b) evaluate implementation strategies used to increase uptake of RI-AIR. In this manuscript, we outline the design and methods used to implement RI-AIR.
Methods:
School-based areas (polygons) with the highest asthma-related urgent healthcare utilization in Greater Providence, R.I., were identified using geospatial mapping. Families with eligible children (2-12 years) living in one of the polygons received evidence-based school- and/or home-based asthma management interventions, based on asthma control level. School-based interventions included child and caregiver education programs and school staff trainings. Home-based interventions included individualized asthma education, home-environmental assessments, and strategies and supplies for trigger remediation. Implementation strategies included engaging school nurse teachers as champions, tailoring interventions to school preferences, and engaging families for input.
Results:
A total of 6420 children were screened throughout the study period, 811 were identified as eligible, and 433 children were enrolled between November 2018 and December 2021.
Conclusions:
Effective implementation of pediatric asthma interventions is essential to decrease health inequities and improve asthma management. The RI-AIR study serves as an example of a multi-level intervention to improve outcomes and reduce disparities in pediatric chronic disease.
Clinical Trials Registration Number:
NCT03583814.
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