TY - JOUR
T1 - An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation
T2 - Trial protocol for the Community Asthma Program
AU - Lowe, A. A.
AU - Simmons, B.
AU - Nez, P.
AU - Begay, E.
AU - Liu, A.
AU - King, D.
AU - Gerald, J. K.
AU - Aaron, Kobernick
AU - Wightman, Patrick
AU - Solomon, Teshia
AU - Crooks, Jim
AU - Phan, H.
AU - Morgan, W.
AU - Bender, B.
AU - Gerald, L. B.
N1 - Funding Information: Supported by one year of funding from the National, Heart, Lung and Blood Institute (U34HL 130762), we engaged over 1500 people on the Navajo Nation through 66 face-to-face meetings to develop an Asthma Care Implementation Program (ACIP). These engagements resulted in widespread community support and commitment to partnerships from the President and Vice President of the Navajo Nation, governmental organizations, healthcare centers, schools, and communities in the three participating agencies (Chinle, Ft. Defiance, and Tuba City). Strategies to guide and facilitate implementation were discussed with key leaders, groups, and organizations and a plan for the “Community Asthma Program” (CAP) was established. Community Advisory Committees (CACs) were created to continue planning and monitoring the implementation of the ACIP. Strengths present on the Navajo Nation that will help assure success of this program include no- or low-cost healthcare and medications in IHS and 638 facilities, transportation resources, a large and well-trained community lay health worker program, and strong community and family commitment to child health. The overall objective of the current study, entitled, “An Asthma Collaboration to reduce Childhood Asthma Disparities on the Navajo Nation”, is to implement evidenced based asthma interventions and evaluate their impact on pediatric asthma outcomes. This work was supported by the National Institutes of Heart, Lung and Blood Institute (U01 HL138689). The primary objective of this clinical trial is to implement and evaluate an integrated and comprehensive evidence-based Asthma Care Implementation Program (ACIP) in three participating Navajo agencies (Tuba City, Chinle and Fort Defiance, Arizona). The intervention will bring together evidenced-based programs, tailored to address the needs and requests articulated by the Navajo community during the engagement year. We hypothesize Navajo children ages 7–17 will experience reduced asthma exacerbations as measured by systemic corticosteroid use, asthma hospitalizations, asthma Emergency Department (ED) visits and Intensive Care Unit (ICU admissions for asthma after completion of the intervention. Publisher Copyright: © 2022 The Authors
PY - 2022/12
Y1 - 2022/12
N2 - Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM (Reach and representativeness, 2) Effectiveness, 3) Adoption, 4) Implementation, and 5) Maintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.
AB - Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM (Reach and representativeness, 2) Effectiveness, 3) Adoption, 4) Implementation, and 5) Maintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.
KW - Asthma
KW - Asthma-management
KW - Children
KW - First Nations
KW - Navajo Nation
KW - RE-AIM
UR - http://www.scopus.com/inward/record.url?scp=85135416793&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135416793&partnerID=8YFLogxK
U2 - 10.1016/j.puhip.2022.100289
DO - 10.1016/j.puhip.2022.100289
M3 - Article
SN - 2666-5352
VL - 4
JO - Public Health in Practice
JF - Public Health in Practice
M1 - 100289
ER -