A response to COVID‐19 school closures: The feasibility of a school‐linked text message intervention as an adaptation to school‐supervised asthma therapy

Abstract

Background: School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention.Objective: The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention.Methods: In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes.Results: Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. Conclusion:A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity.

Pediatric pulmonology 2022 year in review: Asthma

“…Arenas et al 20 enrolled 26 children with asthma in a study utilizing a text message intervention as a substitution for supervised asthma care during the school closures associated with the COVID‐19 pandemic. Patient families were sent daily text reminders to use their preventive asthma medicine.…”

Updates in school-based asthma management

“…This intervention provided daily two-way text message reminders for parents of children with poorly controlled asthma to give their child their asthma controller; parental text responses were shared with the child's school nurse. This intervention was shown to be feasible and acceptable for low-income and minority children and families and for school nurses, with promising improvements in asthma medication adherence and asthma symptoms [57 ▪▪ ]. School-based telemedicine is a feasible approach to bridging asthma care between specialists, primary care providers, and schools, but more work is needed to establish best practices for implementation [52].…”

“…To address the potential digital divide that could be encountered, our approaches must remain accessible for low-income children and families. With this in mind and considering that cell phone use remains nearly universal among low-income and limited English-proficient families, and that text message interventions are favored [56], one recent study described the development and feasibility of the first school-linked text message intervention [57 ▪▪ ]. This intervention provided daily two-way text message reminders for parents of children with poorly controlled asthma to give their child their asthma controller; parental text responses were shared with the child's school nurse.…”