Impacting Environmental and Public Health through the Use of Dual Targeted and Tailored Asthma Educational Interventions

Self-reported prevalence of asthma and its associated factors among adult rural population in Bangladesh: a cross-sectional study using WHO PEN protocol

OBJECTIVE

For over a decade, the prevalence of asthma remained unchanged at around 7% in Bangladesh. Although asthma causes significant morbidity among both children and adults, updates on epidemiological data are limited on the prevalence in Bangladesh. This study attempted to determine the prevalence of asthma, and its modifiable and non-modifiable lifestyle predictors in a rural population of Bangladesh.

METHOD

This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions via census in a rural area of Bangladesh, where self-reported data on asthma were recorded. Data on anthropometric measurement, sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach to surveillance (STEPS) questionnaire. Analysis included descriptive statistics to assess the prevalence of asthma and its risk factors, and binary logistic regression to determine contributing factors.

RESULT

The overall prevalence of asthma was 4.2%. Asthma was predominant among people above 60 years (8.4%). Higher asthma was noted among males (4.6%), self-employed (5.1%), with a family history of asthma (9.1%), with comorbidities besides asthma (7.8%) and underweight (6.0%) compared with their counterparts. The OR of having asthma was 1.89, 1.93, 1.32, 1.50, 2.60, 0.67, 0.67 and 0.78 if a respondent was 45 years old or more, married, underweight, ever smoker, with a family history of asthma, housewife, employed and consumed red meat, respectively, while considering all other variables constant, compared with their counterparts.

CONCLUSION

The study emphasised asthma to be a public health concern in Bangladesh, although it seems to have decreased over the last decade. Among others, red meat intake and nutritional status were strongly associated with asthma, and the linkage among these is still a grey area that needs further exploration.

Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model

Background

In the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families.

Methods

The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children’s schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9–12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test.

Results

The HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children’s school attendance and participation in physical activities and family social events and decreased families’ worry about their asthma management.

Conclusions

The RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02991-8.

Assessing Impact of Household Intervention on Indoor Air Quality and Health of Children with Asthma in the US-Mexico Border: A Pilot Study

Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 μg/m3 on average (p < 0.05). All surveys showed better health outcomes; particularly, quality of life for children was significantly improved (p < 0.05). This pilot study suggests that the combined household intervention might improve IAQ in households and health outcomes for children with asthma and reduce health disparities in low-income communities. Future large-scale studies are needed to verify the effectiveness of this household intervention to improve IAQ and asthma management.

Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study

BACKGROUND

Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities.

METHODS

The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome.

RESULTS

When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance.

CONCLUSIONS

This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.

Evidence-based pediatric asthma interventions and outcome measures in a healthy homes program: An integrative review

OBJECTIVE

Asthma disproportionately impacts and has poorer outcomes in low-income, minority, and inner-city children. The home environment has a profound impact on a child's asthma. Home-based asthma visits have the potential to positively impact a child's asthma, especially in targeted populations. The purpose of this integrative review is 1.) to explore the effectiveness of home-based education and environmental measures and 2.) to explore specific indicators and tools to measure pediatric asthma control and program effectiveness.

DATA SOURCES

Medline, CINHAL, and Ovid databases were searched from 2010 to 2017 utilizing the keywords healthy homes AND asthma and home based interventions AND asthma.

STUDY SELECTIONS

A total of 71 articles were retrieved of which 27 articles met the inclusion criteria of English language, human subjects, and the inclusion of pediatric populations. Three additional articles were hand-searched from previous references. In total, 30 articles were reviewed. A quality appraisal was conducted utilizing standardized appraisal tools.

RESULTS

Home-based asthma education and environmental interventions have proven to be effective. The programs reviewed varied in types of interventions, intensity and duration, the type of provider, length of follow-up, and outcome measures. Successful programs were patient-centered, included a home assessment and individualized education and interventions, and were collaborative. Multiple outcome indicators such as health care utilization, asthma control, missed days of school or productivity, asthma symptoms, and verification of environmental remediation have been utilized.

CONCLUSION

Home-based asthma programs can be beneficial to children with poorly controlled asthma and have the potential to be cost-effective.