Postma Julie M, Smalley Katherine, Ybarra Vickie, Kieckhefer Gail
Washington State University College of Nursing, Spokane, WA, USA.
J Asthma. 2011 Mar;48(2):139-46. doi: 10.3109/02770903.2010.529221. Epub 2010 Nov 3.
The effectiveness of community health worker-delivered interventions to decrease environmental triggers for asthma in the home has been well documented in urban populations, but has had little evaluation in rural, Latino/a families. The purpose of this study was to evaluate the feasibility and acceptability of a home-visitation intervention designed to decrease environmental triggers for pediatric asthma in rural, Latino/a families.
Data from a large community health clinic's pediatric asthma program (2002, 2003, 2004, 2005, 2006) were used to retrospectively explore associations between program participation and asthma-related health outcomes. Demographic data were collected on 866 patients. Behavioral outcomes were evaluated in 374 participants. A medical record abstraction was conducted in a subsample of 400 patients to evaluate asthma-related urgent care use. Nonparametric tests were used to compare outcomes before and after the intervention. Demographic attributes associated with program participation were examined using logistic regression.
Most (91%) participants were Hispanic, and 61% of participants' caregivers were either seasonal or migrant farmworkers. Over half (61%) of the participants did not complete the full intervention. A statistically significant improvement was found in caregivers' abilities to manage asthma medications and adopt behaviors to decrease triggers inside the home. Behaviors related to decreasing outside triggers did not significantly change. Asthma-related urgent care use significantly decreased; however, there was no association between intervention dose and a decrease in urgent care use. Demographic attributes were generally not associated with program completion, having baseline and exit data on intermediate outcomes, and/or inclusion in the chart review.
Results suggest that the asthma intervention helped caregivers improve the air quality in their homes and reduce urgent care admissions among pediatric participants. The intervention dose may be less important than taking part in an intervention to the extent feasible or desired by the family. Findings suggest that policy-level interventions need to address reimbursement for home visitation and environmental exposures that are beyond caregiver control, such as support for healthy and affordable housing in farmworker communities.
社区卫生工作者提供的干预措施对减少城市人群家中哮喘环境触发因素的有效性已有充分记录，但在农村拉丁裔家庭中鲜有评估。本研究的目的是评估一项家访干预措施在农村拉丁裔家庭中减少小儿哮喘环境触发因素的可行性和可接受性。
利用一家大型社区卫生诊所小儿哮喘项目（2002年、2003年、2004年、2005年、2006年）的数据，回顾性探讨项目参与与哮喘相关健康结局之间的关联。收集了866名患者的人口统计学数据。对374名参与者的行为结局进行了评估。对400名患者的子样本进行了病历摘要分析，以评估与哮喘相关的紧急护理使用情况。采用非参数检验比较干预前后的结局。使用逻辑回归分析与项目参与相关的人口统计学特征。
大多数（91%）参与者为西班牙裔，61%参与者的照顾者为季节性或流动农场工人。超过一半（61%）的参与者未完成全部干预。照顾者管理哮喘药物的能力以及采取行为减少家中触发因素方面有统计学显著改善。与减少户外触发因素相关的行为没有显著变化。与哮喘相关的紧急护理使用显著减少；然而，干预剂量与紧急护理使用减少之间没有关联。人口统计学特征一般与项目完成、有中间结局的基线和结局数据以及/或纳入图表审查无关。
结果表明，哮喘干预措施帮助照顾者改善了家中空气质量，并减少了小儿参与者的紧急护理入院次数。干预剂量可能不如在家庭可行或期望的程度上参与干预重要。研究结果表明，政策层面的干预措施需要解决家访报销以及照顾者无法控制的环境暴露问题，例如为农场工人社区提供健康且经济适用住房的支持。
