Alignment of stakeholder agendas to facilitate the adoption of school‐supervised asthma therapy

Abstract

Background School‐supervised inhaled corticosteroid (ICS) therapy improves pediatric asthma medication adherence, outcomes, and morbidity. However, school‐supervised ICS therapy has not been widely adopted into practice. We developed Asthma Link™ as a sustainable, low‐cost model of school‐supervised asthma therapy, designed for real‐world adoption. Initial outcomes of Asthma Link™ demonstrated a significant improvement in health outcomes. Objective In this study, we examined the perspectives of Asthma Link™ participants to identify systems‐level barriers and facilitators to refine the Asthma Link™ protocol and facilitate real‐world uptake of school‐supervised asthma therapy. Methods Using qualitative research methods, we interviewed 29 participants in Asthma Link™ from 2016 to 2018. Semi‐structured interviews were conducted over the phone. Interviews were transcribed and the transcripts were coded to identify major themes within and across stakeholder groups. Results Stakeholders agreed on many facilitators for successful Asthma Link™ execution including the brief and easy to follow procedures and the perceived beneficial health impacts for children involved. Some of the barriers identified were deviations from the protocol and insurance companies denying coverage for two inhalers. However, the participants did propose solutions to address these barriers. Conclusion Asthma Link™ is a low‐cost, sustainable model of school‐supervised asthma therapy that leverages the established infrastructure and collaboration of medical providers, school staff, and families. In this study, we elicited the perspectives from these stakeholder groups and identified an agreement in several facilitators, barriers, and proposed solutions that will ultimately inform refinement of the program protocol and support real‐world adoption of Asthma Link™ and other similar models.

CENTER-IT: a novel methodology for adapting multi-level interventions using the Consolidated Framework for Implementation Research—a case example of a school-supervised asthma intervention

“…Approximately sixty to one hundred children with poorly controlled asthma are enrolled in Asthma Link each school year and enrolled children experience significant decreases in emergency room visits, hospital admissions, and rescue medicine use [ 13 ]. While patients/caregivers, medical providers, and school nurses have found this intervention acceptable, they also identified barriers to successful implementation in practice [ 14 ].…”

“…The results of this first step in our methodology were previously published [ 14 ]. In brief, we interviewed Asthma Link patients and their caregivers, pediatric providers, and school nurses.…”

“…In brief, we interviewed Asthma Link patients and their caregivers, pediatric providers, and school nurses. Barriers reported included medical providers not having time to identify potentially eligible patients during clinical encounters, inability of families to obtain a second inhaler for school, challenges with delivery of the second inhaler to the school, absences in school nurse coverage to supervise medications, and concerns about dissemination and sustainability of the program [ 14 ].

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“…A third party transcribed the recorded interviews, checked for accuracy, and stripped identifying information. Four members of the research team (SH, MS, HS, HS), trained in qualitative analysis, performed thematic content analysis using a deductive approach, guided by the 10 a priori defined constructs [ 14 , 18 ]. The CFIR was an integral part of our analysis; within each a priori construct, specific CFIR constructs guided the content analysis.…”

Updates in school-based asthma management

“…Input from individuals involved as well as school administrators, practice managers, payors and pharmacists allowed for the refinement of Asthma Link intervention itself and guided the choice of outcome measurement for a clinical trial. This stakeholder input has supported the uptake of Asthma Link in real-world practice [39]. For school-based research to effectively be translated into practice, experts have noted that stakeholder priorities should be assessed during each step of the research process [37 ▪▪ ].…”