Using Implementation Science to Design a Community Health Worker Model for Asthma Care

Asthma is one of the most common chronic diseases of childhood, and low-income children are disproportionately affected by both suboptimal preventive care and poor outcomes. Studies have shown that community health worker (CHW) models of care to support self-management of asthma by pediatric patients and families can improve outcomes, but it is not clear how to implement these programs to achieve sustainability and community acceptance. Dr. Stern’s longterm objective is to reduce health disparities in asthma outcomes among children with uncontrolled asthma by implementing effective models of patient and community-centered asthma care. The overall objective of this K23 application is to adapt and pilot a context appropriate and sustainable version of a Community Health Worker asthma care (CHWA) model that focuses on asthma self-management education for children with asthma in Rochester, NY. Our central hypothesis is that a multi-level approach that fully integrates CHWs into communityengaged asthma care will improve self-management and outcomes. The specific aims are: AIM 1: Use rapid scoping review and intervention mapping to identify key components of successful and sustainable CHWA models. Intervention Mapping with key community partners will allow identification of effective intervention components. Using implementation science frameworks, we will assess barriers and facilitators to CHWA model implementation in the local context. We will co-design with community partners a refined, adapted CHWA model, and choose implementation strategies and targeted outcomes for our local context. AIM 2: Pilot a single arm intervention study to evaluate the fidelity, feasibility, acceptability and preliminary clinical effectiveness of a community-designed CHWA model to enhance self-management support for children with persistent asthma. Based on these outcomes, the model will be further refined or adapted in order to plan a larger, R01-funded hybrid effectiveness trial to reduce the pervasive asthma outcome health disparities in this region. Dr. Stern is a physician scientist and early career researcher deeply committed to using implementation science to improve outcomes in asthma care and reduce health disparities. These goals will be advanced by the proposed research aims. This project and training plan will prepare her for a career as an independent investigator focused on reducing asthma and other allergic disease health disparities. Her career development plan includes coursework and experiential learning, including training in: (1) Implementation science methodology and frameworks, (2) Qualitative and mixed methods research, and human-centered design, (3) Health care disparities and community-engaged research, and (4) To enhance scholarly production and leadership. The research will be conducted in an ideal environment at the University of Rochester School of Medicine and Dentistry, with outstanding mentors and resource support and guidance from the Center for Community Health and Prevention.