Community Health Workers Linking Clinics and Schools and Asthma Control: A Randomized Clinical Trial

Area of Science:

• Pediatric pulmonology
• Public health
• Health disparities research

Background:

• Childhood asthma disproportionately affects Black children, with higher hospitalization and death rates.
• Addressing asthma disparities requires interventions across all environments where children live.

Purpose of the Study:

• To evaluate a community health worker (CHW) intervention designed to link primary care, home, and school environments for low-income, minoritized school-aged children with asthma.
• To determine if this integrated approach improves asthma control.

Main Methods:

• A hybrid effectiveness/implementation trial utilizing a 2x2 factorial, cluster randomized clinical trial design.
• Intervention involved CHWs connecting primary care, home, and school settings for 12 months.
• Study conducted in 36 West Philadelphia schools with children aged 5-13 with uncontrolled asthma.

Main Results:

• While all groups showed statistically significant improvements in asthma control, the primary analysis did not reveal clinically meaningful differences.
• Pre-pandemic analysis indicated a significant improvement in asthma control for children receiving the combined clinic-school intervention.
• The COVID-19 pandemic significantly disrupted intervention delivery and data collection.

Conclusions:

• Community health worker (CHW) linkages across lived environments show preliminary promise for improving pediatric asthma care.
• Integrated care models addressing multiple environments are crucial for mitigating asthma disparities.
• Further research is needed to optimize CHW interventions in real-world settings.