Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities

Partnering With Patients With Sarcoidosis to Implement a Community Advisory Board

BACKGROUND

Community advisory boards (CABs) are increasingly recognized as a means of incorporating patient experience into clinical practice and research. The power of CABs is derived from engaging with community members as equals throughout the research process. Despite this, little is known of community member experience and views on best practices for running a CAB in a rare pulmonary disease.

RESEARCH QUESTION

What are CAB members' views on the best practices for CAB formation and maintenance in a rare pulmonary disease?

STUDY DESIGN AND METHODS

In August 2021, we formed the Cleveland Clinic Sarcoidosis Health Partners (CC-HP) as a CAB to direct research and clinic improvement initiatives at a quaternary sarcoidosis center. We collaboratively evaluated our process for formation and maintenance of the CC-HP with the patient members of the group. Through the series of reflection/debriefing discussions, CAB patient members developed a consensus account of salient obstacles and facilitators of forming and maintaining a CAB in a rare pulmonary disease.

RESULTS

Clinician and community members of the CC-HP found published guidelines to be an effective tool for structuring formation of a CAB in a rare pulmonary disease. Facilitators included a dedicated coordinator, collaborative development of projects, and a focus on improving clinical care. Obstacles to CAB functioning were formal structure, focus on projects with academic merit but no immediate impact to patients, and overreliance on digital resources.

INTERPRETATION

By centering our evaluation of our CAB on community member experience, we were able to both identify facilitators and impediments to CAB as well as improve our own processes.

Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation

BACKGROUND

Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States.

METHODS

This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework.

RESULTS

Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women.

CONCLUSIONS

Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.

The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: A scoping review

Interventions involving direct community stakeholders include a variety of approaches in which members take an active role in improving their health. We evaluated studies in which the community has actively participated to strengthen tuberculosis prevention and care programs. A literature search was performed in Pubmed, Scopus, ERIC, Global Index Medicus, Scielo, Cochrane Library, LILACS, Google Scholar, speciality journals, and other bibliographic references. The primary question for this review was: ¿what is known about tuberculosis control interventions and programs in which the community has been an active part?. Two reviewers performed the search, screening, and selection of studies independently. In cases of discrepancies over the eligibility of an article, it was resolved by consensus. 130 studies were selected, of which 68.47% (n = 89/130) were published after 2010. The studies were conducted in Africa (44.62%), the Americas (22.31%) and Southeast Asia (19.23%). It was found that 20% (n = 26/130) of the studies evaluated the participation of the community in the detection/active search of cases, 20.77% (n = 27/130) in the promotion/prevention of tuberculosis; 23.07% (n = 30/130) in identifying barriers to treatment, 46.15% (n = 60/130) in supervision during treatment and 3.08% (n = 4/130) in social support for patient. Community participation not only strengthens the capacities of health systems for the prevention and care of tuberculosis, but also allows a better understanding of the disease from the perspective of the patient and the affected community by identifying barriers and difficulties through of the tuberculosis care cascade. Engaging key community stakeholders in co-creating solutions offers a critical pathway for local governments to eradicate TB.

Unveiling the power of neutral and inclusive language in tuberculosis prevention and care

Language plays a crucial role in shaping discourses and responses related to disease, particularly tuberculosis (TB). Stigmatising language and attitudes surrounding TB can lead to discrimination and marginalisation of affected individuals, creating barriers to seeking proper diagnosis and treatment. The terminology used to describe TB-affected individuals can be disempowering and criminalising, reinforcing an "othering" of those affected. To combat this, engaging with TB-affected communities is essential to co-construct a neutral and inclusive vocabulary that respects the dignity of individuals and fosters empathy and support. Thus, an inclusive language approach empowers affected individuals as active participants in their health management, encouraging open communication and the development of support networks. By adopting a neutral and inclusive language system, healthcare providers and communities can work together to remove unnoticed hurdles and align with the World Health Organization's TB care and prevention goals.

Health Disparities: Interventions for Pulmonary Disease - A Narrative Review

There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.

The community as an active part in the implementation of interventions for the prevention and control of tuberculosis: a scoping review

Interventions involving direct community stakeholders include a variety of approaches in which members take an active role in improving their health. We evaluated studies in which the community has actively participated to strengthen tuberculosis prevention and control programs. A literature search was performed in Pubmed, Scopus, ERIC, Global Index Medicus, Scielo, Cochrane Library, LILACS, Google Scholar, speciality journals, and other bibliographic references. The primary question for this review was: what is known about tuberculosis control interventions and programs in which the community has been an active part?. Two reviewers performed the search, screening and selection of studies independently. In cases of discrepancies over the eligibility of an article, it was resolved by consensus. 130 studies were selected, of which 68.47% (n=89/130) were published after 2010. The studies were conducted in Africa (44.62%), the Americas (22.31%) and Southeast Asia (19.23%). It was found that 20% (n=26/130) of the studies evaluated the participation of the community in the detection/active search of cases, 20.77% (n=27/130) in the promotion/prevention of tuberculosis; 23.07% (n=30/130) in identifying barriers to treatment, 46.15% (n=60/130) in supervision during treatment and 3.08% (n=4/130) in social support for patient. Community participation not only strengthens the capacities of health systems for the prevention and control of tuberculosis, but also allows a better understanding of the disease from the perspective of the patient and the affected community by identifying barriers and difficulties through of the tuberculosis care cascade. Engaging key community stakeholders in co-creating solutions offers a critical pathway for local governments to eradicate TB.

Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.

Enhancing Recruitment and Retention of Minority Populations for Clinical Research in Pulmonary, Critical Care, and Sleep Medicine: An Official American Thoracic Society Research Statement

Background: Well-designed clinical research needs to obtain information that is applicable to the general population. However, most current studies fail to include substantial cohorts of racial/ethnic minority populations. Such underrepresentation may lead to delayed diagnosis or misdiagnosis of disease, wide application of approved interventions without appropriate knowledge of their usefulness in certain populations, and development of recommendations that are not broadly applicable.Goals: To develop best practices for recruitment and retention of racial/ethnic minorities for clinical research in pulmonary, critical care, and sleep medicine.Methods: The American Thoracic Society convened a workshop in May of 2019. This included an international interprofessional group from academia, industry, the NIH, and the U.S. Food and Drug Administration, with expertise ranging from clinical and biomedical research to community-based participatory research methods and patient advocacy. Workshop participants addressed historical and current mistrust of scientific research, systemic bias, and social and structural barriers to minority participation in clinical research. A literature search of PubMed and Google Scholar was performed to support conclusions. The search was not a systematic review of the literature.Results: Barriers at the individual, interpersonal, institutional, and federal/policy levels were identified as limiting to minority participation in clinical research. Through the use of a multilevel framework, workshop participants proposed evidence-based solutions to the identified barriers.Conclusions: To date, minority participation in clinical research is not representative of the U.S. and global populations. This American Thoracic Society research statement identifies potential evidence-based solutions by applying a multilevel framework that is anchored in community engagement methods and patient advocacy.

Impact of COVID-19 on services for people with disabilities and chronic health conditions

BACKGROUND

People with disabilities and chronic health conditions rely on a range of services and supports to complete daily tasks, maintain health, and participate in the community. Preliminary research suggests the COVID-19 pandemic greatly disrupted these services and this population may be particularly susceptible to unemployment.

OBJECTIVE

Describe employment and service disruptions for individuals with disabilities and chronic health conditions during the onset of community-based spread of COVID-19 in the United States.

METHODS

Adults with disabilities and chronic health conditions completed online surveys to report employment and service changes via multiple choice and open-ended questions. Multiple choice questions were analyzed using descriptive statistics; open-ended responses were coded using content analysis.

RESULTS

Participants (n = 109): 79.8% female, 88.1% white, 77.121% completed a 4-year college degree or greater, 61.4% had annual income ≥$45,000. Only 14.9% of survey respondents reported disruptions in employment. On average, 54.0% of service changes were due to discontinuation, including loss of physical therapy, job coaching, community organizations, transportation, and peer supports. Other changes included a shift to virtual service delivery and family members taking the role of service providers.

CONCLUSIONS

Individuals with chronic health conditions and disabilities experienced service disruptions, even in a sample with considerably more economic, social, and educational privilege than the general population of people with chronic health conditions and disabilities in the United States.

Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: a community-based mixed-method, observational study

BACKGROUND

Globally the burden of Obstructive Lung Diseases (OLD) is growing, however its effect on urban poor populations with the high prevalence of tobacco dependence is virtually unknown. The purpose of this project is to estimate the prevalence and burden of OLD in the urban, low-income populations of Ottawa, Canada.

METHODS

The study presented in this paper was part of the PROMPT (Management and Point-of-Care for Tobacco Dependence) project; a prospective cohort study in a community-based setting (n = 80) with meaningful Patient Engagement from design to dissemination. Spirometry data, standardized questionnaires and semi-structured interviews from PROMPT were interpreted to understand the lung function, disease burden and social determinants (respectively) in this population.

RESULTS

The prevalence of OLD among those who completed spirometry (N = 64) was 45-59%. Generic and disease-specific quality of life was generally poor in all PROMPT participants, even those without OLD, highlighting the higher disease burden this vulnerable population faces. Quality of life was impacted by two major themes, including i) socioeconomic status and stress and ii) social networks and related experiences of trauma.

CONCLUSION

The prevalence and disease burden of OLD is significantly higher in Ottawa's urban poor population than what is observed in the general Canadian population who smoke, suggesting an etiological role of the social determinants of health. This urges the need for comprehensive care programs addressing up-stream factors leading to OLDs, including poor access and utilization of preventive healthcare addressing the social determinants of health.

TRIAL REGISTRATION

ClinicalTrails.gov - NCT03626064 , Retrospective registered: August 2018.

A structured collaborative approach to intervention design using a modified intervention mapping approach: a case study using the Management and Interventions for Asthma (MIA) project for South Asian children

BACKGROUND

To describe how using a combined approach of community-based participatory research and intervention mapping principles could inform the development of a tailored complex intervention to improve management of asthma for South Asian (SA) children; Management and Interventions for Asthma (MIA) study.

METHODS

A qualitative study using interviews, focus groups, workshops, and modified intervention mapping procedures to develop an intervention planning framework in an urban community setting in Leicester, UK. The modified form of intervention mapping (IM) included: systematic evidence synthesis; community study; families and healthcare professionals study; and development of potential collaborative intervention strategies. Participants in the community study were 63 SA community members and 12 key informants; in-depth semi-structured interviews involved 30 SA families, 14 White British (WB) families and 37 Healthcare Professionals (HCPs) treating SA children living with asthma; prioritisation workshops involved 145 SA, 6 WB and 37 HCP participants; 30 participants in finalisation workshops.

RESULTS

Two key principles were utilised throughout the development of the intervention; community-based participatory research (CBPR) principles and intervention mapping (IM) procedures. The CBPR approach allowed close engagement with stakeholders and generated valuable knowledge to inform intervention development. It accounted for diverse perceptions and experiences with regard to asthma and recognised the priorities of patients and their families/caregivers for service improvement. The 'ACT on Asthma' programme was devised, comprising four arms of an intervention strategy: education and training, clinical support, advice centre and raising awareness, to be co-ordinated by a central team.

CONCLUSIONS

The modified IM principles utilised in this study were systematic and informed by theory. The combined IM and participatory approach could be considered when tailoring interventions for other clinical problems within diverse communities. The IM approach to intervention development was however resource intensive. Working in meaningful collaboration with minority communities requires specific resources and a culturally competent methodology.

Metal air pollution partnership solutions: building an academic-government-community-industry collaboration to improve air quality and health in environmental justice communities in Houston

BACKGROUND

From 2006 to 2011, the City of Houston received nearly 200 community complaints about air pollution coming from some metal recycling facilities. The investigation by the Houston Health Department (HHD) found that while operating within legal limits, emissions from facilities that use torch cutting, a technique generating metal aerosols, may increase health risks for neighboring residents. Choosing to use collaborative problem solving over legislative rulemaking, HHD reached out to The University of Texas Health Science Center at Houston (UTHealth) to further evaluate and develop plans to mitigate, if necessary, health risks associated with metal emissions from these facilities.

METHODS

Utilizing a community-based participatory research approach, we constituted a research team from academia, HHD and an air quality advocacy group and a Community Advisory Board (CAB) to draw diverse stakeholders (i.e., frustrated and concerned residents and wary facility managers acting within their legal rights) into an equitable, trusting and respectful space to work together. Next, we investigated metal air pollution and inhalation health risks of adults living near metal recyclers and ascertained community views about environmental health using key informant interviews, focus groups and surveys. Finally, working collaboratively with the CAB, we developed neighborhood-specific public health action plans to address research findings.

RESULTS

After overcoming challenges, the CAB evolved into an effective partnership with greater trust, goodwill, representation and power among members. Working together to translate and share health risk assessment results increased accessibility of the information. These results, coupled to community survey findings, set the groundwork for developing and implementing a stakeholder-informed action plan, which included a voluntary framework to reduce metal emissions in the scrap yard, improved lines of communication and environmental health leadership training. Tangible outcomes of enhanced capacity of our community and governmental partners included trained residents to conduct door-to-door surveys, adaptation of our field training protocol and survey by our community partner and development of a successful HHD program to engage residents to improve environmental health in their neighborhood.

CONCLUSIONS

Academic-government-community-industry partnerships can reduce environmental health disparities in underserved neighborhoods near industrial facilities.

The High Obesity Program: Overview of the Centers for Disease Control and Prevention and Cooperative Extension Services Efforts to Address Obesity

The burden of obesity and other chronic diseases negatively affects the nation’s health, businesses, economy, and military readiness. The prevalence is higher in certain geographic locations. Beginning in 2014, the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity awarded funding to 11 land-grant universities through the High Obesity Program. This program implemented evidence- and practice-based strategies with a goal to increase access to nutritious foods and places to be physically active in counties in which the prevalence of obesity among adults was more than 40%. In these counties, funded land-grant universities developed partnerships and collaborations to work with community organizations, public health agencies, and other stakeholders to promote policy and environmental changes that address obesity. Data were collected by the Cooperative Extension Service in each selected county with technical assistance from land-grand universities and the Centers for Disease Control and Prevention. More than 2 million people were reached by the nutrition and physical activity policy, systems, and environmental interventions implemented.

Addressing the Needs of Abused Chinese Women Through a Community-Based Participatory Approach

PURPOSE

Intimate partner violence against women is a priority global health issue. It has had serious negative consequences on women's health and has led to huge burdens on the community. Numerous interventions have been demonstrated to have positive effects, and the majority of them have been developed using a top-down approach. However, the specific needs of abused Chinese women have not been fully addressed; incorporating women's input seems to be an essential element for the success of any intervention. This article describes the experiences and success in using a community-based participatory approach (CBPA) to develop a culturally appropriate intervention for abused Chinese women in order to address their multifaceted needs.

DESIGN

A CBPA was adopted in this study to develop a culturally appropriate intervention in order to address the multifaceted needs of abused Chinese women.

METHODS

A core group of six participants (three abused Chinese women, one researcher, and two social workers who provided community services for abused Chinese women) was formed in a local community center in Hong Kong. The three Chinese women were recruited from the local community center, and according to the Abuse Assessment Screen they had been in an intimate relationship in the preceding 12 months and had been abused by an intimate partner.

FINDINGS

Three core group meetings were conducted over 6 weeks for intervention development. An integrated multicomponent intervention was developed, comprising a four-part, women-centered program called "Women-centred, we are with you." The program was implemented and completed over 4 months (October 2015 to January 2016). Eighteen abused Chinese women participated in the intervention.

CONCLUSIONS

A CBPA provides actual empowerment spirit for abused Chinese women. This approach was well accepted by the women and enabled them to develop more culturally appropriate interventions in fulfilling their specify needs.

CLINICAL RELEVANCE

Researchers can consider using a CBPA to develop and tailor a culturally appropriate intervention for groups such as abused Chinese women in order to improve their health and eliminate disparities by addressing their specific and multifaceted needs.

Exploring the unmet needs for creating an enabling environment for nurturing care to promote migrant child health in Bishkek, Kyrgyzstan: A theory-guided community-based participatory action research

Empirical evidence on community-driven child health promotion programs in disadvantaged migrant populations is limited despite various promotional strategies. Therefore, we implemented a developmental process to shape child health interventions using theory-guided community-based participatory action research (CBPAR) in a migrant community in Bishkek, Kyrgyzstan between 2015 and 2019. The collaborative and iterative CBPAR process was conducted through participatory workshops and focus group discussions with support from trusting and collegial partnerships between community members and the research team. The goal and scope of the intervention was guided by enabling environments for nurturing care, including the four domains of caregivers' capabilities, empowered communities, supportive services, and enabling policies. Diverse interests and needs identified by community members were aggregated in the theoretical model and reflected in the intervention. Community-driven intervention is perceived as a culturally acceptable, sustainable, sensitive and relevant approach to solve problems. There are several challenges in conducting the CBPAR, such as the effort and time spent on building partnerships, co-learning and mutual understanding, and the power equilibrium involved. Despite this, the success of the CBPAR process provided opportunities for community mobilization, empowerment and sustainability of the intervention. Evaluation of the process and outcomes of the intervention provided community health researchers and practitioners with evidence of the theory-guided community participatory approach.

Strategies for recruitment and retention of underrepresented populations with chronic obstructive pulmonary disease for a clinical trial

BACKGROUND

Recruitment and retention are two significant barriers in research, particularly for historically underrepresented groups, including racial and ethnic minorities, patients who are low-income, or people with substance use or mental health issues. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and disproportionately affects many underrepresented groups. The lack of representation of these groups in research limits the generalizability and applicability of clinical research and results. In this paper we describe our experience and rates of recruitment and retention of underrepresented groups for the Aides in Respiration (AIR) COPD Health Coaching Study.

METHODS

A priori design strategies included minimizing exclusion criteria, including patients in the study process, establishing partnerships with the community clinics, and ensuring that the health coaching intervention was flexible enough to accommodate patient needs.

RESULTS

Challenges to recruitment included lack of spirometric data in patient records, space constraints at the clinic sites, barriers to patient access to clinic sites, lack of current patient contact information and poor patient health. Of 282 patients identified as eligible, 192 (68%) were enrolled in the study and 158 (82%) completed the study. Race, gender, educational attainment, severity of disease, health literacy, and clinic site were not associated with recruitment or retention. However, older patients were less likely to enroll in the study and patients who used home oxygen or had more than one hospitalization during the study period were less likely to complete the study. Three key strategies to maximize recruitment and retention were identified during the study: incorporating the patient perspective, partnering with the community clinics, and building patient rapport.

CONCLUSIONS

While the AIR study included design features to maximize the recruitment and retention of patients from underrepresented groups, additional challenges were encountered and responded to during the study. We also identified three key strategies recommended for future studies of COPD and similar conditions. Incorporating the approaches described into future studies may increase participation rates from underrepresented groups, providing results that can be more accurately applied to patients who carry a disparate burden of disease.

TRIAL REGISTRATION

This trial was registered at ClinicalTrial.gov at identifier NCT02234284 on August 12, 2014. Descriptor number: 2.9 Racial, ethnic, or social disparities in lung disease and treatment.

Innovating for Transformation in First Nations Health Using Community-Based Participatory Research

Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.

Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

OBJECTIVE

To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control.

METHODS

Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors.

RESULTS

Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss.

CONCLUSION

Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.