Development and tailoring of a peer-administered asthma management intervention for urban Latino middle school...

Children from Latino backgrounds face unique challenges in managing asthma. Barriers are compounded when children live in urban settings and are exposed to urban stressors (e.g. barriers to medication use, neighborhood stress). Asthma management in schools is often directly implicated. This study aims to address these gaps in care by developing a 4-session, peer-facilitated, culturally tailored asthma self-management group intervention in urban public-school settings.

We developed and tested the ASMAS (Asthma Self-Management in Schools) intervention, utilizing an iterative process guided by previous work and theoretical models. Feedback from focus groups was used to further tailor ASMAS. We enrolled 81 middle school students in a cross-site pilot randomized controlled trial (RCT) to evaluate the efficacy of ASMAS compared both to Attention Control and No-Treatment Control conditions. Outcomes included asthma control, asthma-related sleep disruption, school absences, asthma self-efficacy, and availability of rescue inhaler and asthma action plan (AAP) at school.

Compared to Attention Control participants, youth who received ASMAS had improved asthma outcomes over time (baseline to end-of-treatment) including asthma control (t = 2.1, p<.05, d = .4, M_diff = 1.5), asthma-related sleep disruptions (t = -0.24, p <.05, d = -0.4, M_diff = -3.6), school absences (d = -0.2), asthma management self-efficacy (t = 2.3, p <.05, d = .4, M_diff = 0.3) and rates of AAP (t = 1.8, p = .06; d = .3, M_diff = 20%) and rescue inhalers availability (t = 2.0, p <.01, d = .7, M_diff = 23%). Similar patterns were maintained at 4-month follow-up.

Results demonstrate ASMAS' feasibility and highlight the potential benefits of the tailored asthma intervention. A full-scale RCT to evaluate ASMAS' effectiveness, implementation, and sustainability is warranted.