Addressing asthma and obesity in children with community health workers: proof-of-concept intervention development

Abstract

BackgroundThe objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity.MethodsUsing a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5–12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI).ResultsFamilies received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012).ConclusionsThe CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.

The role and impact of community health workers in childhood obesity interventions: a systematic review and meta‐analysis

“…Most interventions were delivered in the United States, with the exception of two studies that were based in Auckland, New Zealand and Melbourne, Australia . Three of the American studies were based in California , and three were based in New England ; most American studies were based in urban settings . Sample sizes varied, ranging from 33 to 3,765 (mean 792, SD 72; 9 with samples <1,000).…”

“…Sample sizes varied, ranging from 33 to 3,765 (mean 792, SD 72; 9 with samples <1,000). Target ages included children from throughout the developmental spectrum; sample ages ranged from 24 months (mothers recruited during pregnancy) , young children (3–5 years) , school age (5–12 years) , to adolescents . No intervention was gender‐specific.…”

“…No intervention was gender‐specific. Other sample characteristics included Latino/Latina , American Indian , African American , from low income households and/or receiving care at Federally Qualified Health Center , or diagnosed with asthma . The intervention based in New Zealand contained approximately 50% children of Maori/Pacific ethnicity .…”

“…The intervention based in New Zealand contained approximately 50% children of Maori/Pacific ethnicity . Six of the 11 interventions focused on children with overweight and obesity or obesity only . Most interventions lasted 6–12 months (mean 15.8 months, SD 1.4 months), although the shortest lasted 10 weeks and the longest lasted 3.5 years .…”

“…Six of the 11 interventions focused on children with overweight and obesity or obesity only . Most interventions lasted 6–12 months (mean 15.8 months, SD 1.4 months), although the shortest lasted 10 weeks and the longest lasted 3.5 years . Theoretical models and frameworks guiding interventions included Social Cognitive Theory , the Chronic Care Model , Health Belief Model , Transtheoretical Model , behavioural economics , the Warnecke Model for Analysis of Population Health and Health Disparities , the World Health Organization Health Promoting Schools Framework and the International Obesity Task Force 10 Guiding Principles for Obesity Prevention .…”