Efficacy of a lay community health worker (promotoras de salud) program to improve adherence to emollients in Spanish‐speaking Latin American pediatric patients in the United States with atopic dermatitis: A randomized, controlled, evaluator‐blinded study

Abstract

Background: Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. Objective: To create and evaluate a promotora-led education program for Spanishspeaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. Methods: Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. Results: Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%-61%]) versus non-promotora (median [IQR]: 20% [11%-49%])

Adherence to treatment in dermatology: Literature review

“…13,15 For instance, the Medication Event Monitoring Systems (MEMS; Aardex) contains microprocessors that record the date and time when medication bottles are opened. 23 GlowCap and AdhereTech devices are two examples of more recent electronic pill bottle technologies that have the capacity to wirelessly send patient medication adherence data, offering options to analyze and monitor patient medication adherence in real time. 24 However, these proxies for adherence can lead to inaccurate estimates.…”

“…54,55 Several studies have been done to assess the association between educational programmes and workshops on patient self-expertise and adherence (Table 2). These interventions, which consistently improved patients' knowledge, 17,23,54,55,64 had mixed results on adherence changes. For example, one study using informational videos and leaflets targeting common misconceptions of topical corticosteroids (TCS) did not increase TCS adherence.…”

“…Interventions that increased patient knowledge with improved communication clarity and increased patient support contributed to better adherence results (Table 2). 23,55,64,65 For example, a promotora (community health worker)-led education programme for Spanishspeaking caregivers of Latin American, paediatric patients with AD, resulted in a greater than twofold increase in adherence rates. 23 Sustained adherence to topical treatments at week 12 in the promotora compared to the nonpromotora group (46% vs. 17%) may have been due to the continued reinforcement and culturally appropriate education received in the promotora group.…”

“…23,55,64,65 For example, a promotora (community health worker)-led education programme for Spanishspeaking caregivers of Latin American, paediatric patients with AD, resulted in a greater than twofold increase in adherence rates. 23 Sustained adherence to topical treatments at week 12 in the promotora compared to the nonpromotora group (46% vs. 17%) may have been due to the continued reinforcement and culturally appropriate education received in the promotora group. In nurse-led clinics where patients had longer consultations and were given specific education regarding the aetiology and management of their disease, improved adherence, quality of life, and clinical outcomes were seen.…”