An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program

A A Lowe; B Simmons; P Nez; E Begay; A Liu; D King; J K Gerald; Kobernick Aaron; Patrick Wightman; Teshia Solomon; Jim Crooks; H Phan; W Morgan; B Bender; L B Gerald

doi:10.1016/j.puhip.2022.100289

An asthma collaboration to reduce childhood asthma disparities on the Navajo Nation: Trial protocol for the Community Asthma Program

Public Health Pract (Oxf). 2022 Jul 21:4:100289. doi: 10.1016/j.puhip.2022.100289. eCollection 2022 Dec.

Authors

A A Lowe¹, B Simmons², P Nez², E Begay¹, A Liu³, D King⁴, J K Gerald^{1

5}, Kobernick Aaron⁶, Patrick Wightman⁷, Teshia Solomon⁸, Jim Crooks⁹, H Phan¹⁰, W Morgan^{1

11}, B Bender², L B Gerald^{1

12}

Affiliations

¹ Asthma & Airway Disease Research Center, University of Arizona, Tucson, AZ, USA.
² Department of Pediatrics, Center for Health Promotion, National Jewish Health, Denver, CO, USA.
³ Children's Colorado, Anschutz Medical Campus, Aurora, CO, USA.
⁴ Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Anchorage, Anchorage, AK, USA.
⁵ Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
⁶ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
⁷ Center for Population Science & Discovery, University of Arizona Health Sciences, Tucson, AZ, USA.
⁸ Department of Family & Community Medicine, University of Arizona, Tucson, AZ, USA.
⁹ Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA.
¹⁰ Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
¹¹ Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, USA.
¹² Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.

Abstract

Navajo children disproportionately experience poor asthma outcomes. Following a one-year community engagement period with key stakeholders from the Navajo Nation, the Community Asthma Program (CAP) was created using evidenced based programs with the goal of reducing asthma disparities among Navajo children. CAP is being evaluated with a six-year, multi-site step-wedge design in three Navajo communities: Tuba City, Chinle and Fort Defiance, Arizona. The primary outcome is asthma exacerbations defined as use of systemic oral corticosteroids, asthma hospitalizations, asthma related ED visits, and ICU admissions. Asthma exacerbations will be measured using data from the electronic medical records of the three community health care centers. Secondary outcomes include will changes in asthma-related events and asthma control. The RE-AIM ( R each and representativeness, 2) E ffectiveness, 3) A doption, 4) I mplementation, and 5) M aintenance) framework is being used to guide the implementation evaluation which includes iterative collection and analysis of process data to identify facilitators and barriers, describe relevant organizational contexts, and inform strategies for dissemination. The CAP intervention requires community engagement and participation, building community capacity, incorporating evidenced-based guidelines and practices while ensuring program strategies actively involve Navajo community members during all steps of the intervention. The outcome of this trial will allow us to determine the effectiveness of a multi-component, community-focused intervention to improve asthma in a tribal community.

Keywords: Asthma; Asthma-management; Children; First Nations; Navajo Nation; RE-AIM.