Impact of a Community Care Intervention to Increase the Uptake of Respiratory Illness Prevention Behaviors Among Adults Suffering from Chronic Illness

Individuals with chronic illness suffer unduly from respiratory diseases. Analysis of respiratory illness prevention behavior data suggest multiple determinants of variation in respiratory illness prevention behaviors among different patient population groups. These include poor access to care and lack of literacy-appropriate factual information to promote awareness of and motivation to partake in protective behaviors to prevent respiratory illnesses Integrated within health and community systems alike, community health worker (CHW) interventions are an effective strategy to address respiratory illness prevention behaviors barriers in multiple settings. Building on a long-standing partnership between RAND, Clinical Directors Network (CDN), and local community groups and leaders, we propose a study to tailor, implement and evaluate a CHW intervention (CHW-I) to protect against respiratory diseases among individuals with chronic illness who receive their primary care in Federally Qualified Health Centers (FQHCs). Tailoring of the CHW intervention will be grounded on the Capability, Opportunity, Motivation, Behavior (COM-B) theoretical behavioral model and in partnership with a Community Advisory Board (CAB) composed of patients and representatives from local community organizations. We propose a randomized controlled trial (RCT) to determine the efficacy of the CHW-I to prevent respiratory illnesses intervention to improve protective behavior acceptance, uptake, and implementation among adults with any of 7 chronic conditions (asthma, diabetes, hypertension, obesity, depression, anxiety disorder, or PTSD). The study has 4 aims over 5 years: 1) tailor the CHW intervention based on formative research (Aim 1: Year 1); 2) conduct the RCT to test the efficacy of CHW-VB (Aim 2: Years 2-4); 3) understand the effects of CHW- and examine measures of capability, motivation, and opportunity as mediators and demographic characteristics and chronic medical/mental conditions as moderators (Aim 3: Years 3-4); and, 5) assess contextual factors affecting implementation and sustainability (Aim 4: Year 5). Our community-based participatory research approach is anchored in partnership with the CAB in all stages of the research, through regular meetings for the formative assessment, co-designing the adaptation of the intervention, troubleshooting any implementation hurdles, and actively participating in the interpretation and dissemination of the results. FHQCs employ CHWs as part of the lifeline of health care services delivered to patients with chronic illnesses. Community engagement is also a core value for FQHCs who are governed by individuals and community-based agencies from the communities they serve. The CHW-intervention, if efficacious, has a high potential for scalability and sustainability in this setting.