A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers

Abstract

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. Randomized controlled trial. Community and public health clinics and homes. Three hundred nine children aged 3 to 13 years with asthma living in low-income households. 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. Asthma symptom–free days, Pediatric Asthma Caretaker Quality of Life Scale score, and use of urgent health services. 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. 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.