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February 2, 2009

A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers: The Seattle–King County Healthy Homes II Project

Author Affiliations

Author Affiliations: University of Washington School of Medicine and School of Public Health and Community Medicine, Seattle (Dr Krieger); Public Health–Seattle & King County, Seattle (Drs Krieger and Song, and Ms Edwards); Simon Fraser University, Vancouver, British Columbia, Canada (Dr Takaro); and Occupational and Environmental Medicine Program, and Pediatric Environmental Health Specialty Unit, University of Washington, Seattle (Ms Beaudet).

Arch Pediatr Adolesc Med. 2009;163(2):141-149. doi:10.1001/archpediatrics.2008.532

Objective  To compare the marginal benefit of in-home asthma self-management support provided by community health workers (CHWs) with standard asthma education from clinic-based nurses.

Design  Randomized controlled trial.

Setting  Community and public health clinics and homes.

Participants  Three hundred nine children aged 3 to 13 years with asthma living in low-income households.

Interventions  All participants received nurse-provided asthma education and referrals to community resources. Some participants also received CHW-provided home environmental assessments, asthma education, social support, and asthma-control resources.

Outcome Measures  Asthma symptom–free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services.

Results  Both groups showed significant increases in caretaker quality of life (nurse-only group: 0.4 points; 95% confidence interval [CI], 0.3-0.6; nurse + CHW group: 0.6 points; 95% CI, 0.4-0.8) and number of symptom-free days (nurse only: 1.3 days; 95% CI, 0.5-2.1; nurse + CHW: 1.9 days; 95% CI, 1.1-2.8), and absolute decreases in the proportion of children who used urgent health services in the prior 3 months (nurse only: 17.6%; 95% CI, 8.1%-27.2%; nurse + CHW: 23.1%; 95% CI, 13.6%-32.6%). Quality of life improved by 0.22 more points in the nurse + CHW group (95% CI, 0.00-0.44; P = .049). The number of symptom-free days increased by 0.94 days per 2 weeks (95% CI, 0.02-1.86; P = .046), or 24.4 days per year, in the nurse + CHW group. While use of urgent health services decreased more in the nurse + CHW group, the difference between groups was not significant.

Conclusion  The addition of CHW home visits to clinic-based asthma education yielded a clinically important increase in symptom-free days and a modest improvement in caretaker quality of life.