Leveraging brief annual pauses in implementation: Using a rapid qualitative approach to inform iterative planning and...

Asthma is a prevalent chronic pediatric condition associated with significant health disparities. The Better Asthma Control for Kids (BACK) program aims to reduce asthma disparities and improve asthma control for children in high-need schools in four regions of Colorado.

We conducted in-depth, semi-structured interviews (Dec 2023-June 2024) with key roles involved in BACK including school nurses, asthma navigators, and caregivers of participating students with asthma. Interviews and rapid qualitative analysis were informed by the Practical Robust, Implementation, and Sustainability Model (PRISM). We gathered perspectives, feedback, and recommendations about BACK to inform adaptation of the intervention and implementation strategy packages.

Participants (n = 39) included 6 asthma navigators, 17 school nurses, and 16 caregivers. Four overarching themes emerged: 1) perceived benefits of the BACK program, 2) challenges with school nurse engagement, communication, and perceptions of BACK, 3) difficulty with identification, documentation, and enrollment of students with asthma at the beginning of the school year, and 4) mismatches in program scope and alignment with school and family contexts.

Identifying key challenges and participant recommendations supported the research team's "adapt and tailor to context" strategy in annual rapid evaluation and planning cycles. Obtaining feedback from program adopters, implementers, and recipients led to complementary recommendations to improve program delivery and user experiences. This approach may be transferable to other implementation-effectiveness trials, particularly those in schools or with other natural pauses that facilitate annual iterations in program delivery.

Clinicaltrials.gov identifier NCT06003569, registered on August 22, 2023, https://clinicaltrials.gov/study/NCT06003569.