Community Health Workers and Environmental Interventions for Children with Asthma: A Systematic Review

Abstract

Community health worker (CHW)-delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; (2) delivered by a CHW; (3) delivered to families with children with asthma; and (4) addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies. Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model identifying pathways for future investigation is presented.

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…[1][2][3] As value-based payment models expand, providers will have more flexibility to fund CHWs with global budgets, or payers may elect to reimburse for CHW services. [4][5][6] The emerging evidence base on CHW programs 7 for the prevention and management of chronic diseases includes systematic reviews concluding that CHW interventions can improve overall health outcomes 8 and outcomes for patients with heart disease, stroke, 9 type II diabetes, [10][11][12] HIV, 13 and asthma 2,14 and for vulnerable patients with or at risk for a variety of chronic diseases or cancer. 15 Other systematic reviews have also documented the costs and cost-effectiveness of CHW programs, 15 but none, outside of low and middle-income countries, 16 have examined the impact of CHWs on the utilization of health services by patients with chronic conditions.…”

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…120,124,129 Bailey et al 120 looked at broad asthma programmes, whereas Chang et al 124 explored education specifically, and Postma et al 129 focused on environmental interventions. All three included interventions undertaken with any ethnic minority, and identified the following groups: Puerto Rican; African American; Hispanic; and Indian subcontinent.…”

“…Three reviews specifically explore culturally tailored interventions for ethnic minority groups. 120,124,129 Six look at interventions targeted towards asthmatic children or adolescents. 118,119,121,122,125,134 The remaining nine target less specific populations and include children, adolescents, adults, HCPs, and ethnic majorities and minorities.…”

“…In one review, all population groups resided in the USA. 129 Interventions were delivered by asthma educators fluent in participants' own dialect, 120 indigenous health-care workers (IHWs) 124 and CHWs who generally lived or worked in the same community as participants. 129 As well as interventions being delivered by culturally or linguistically competent personnel, culturally relevant issues were also addressed within these interventions, and all were home based.…”

“…129 Interventions were delivered by asthma educators fluent in participants' own dialect, 120 indigenous health-care workers (IHWs) 124 and CHWs who generally lived or worked in the same community as participants. 129 As well as interventions being delivered by culturally or linguistically competent personnel, culturally relevant issues were also addressed within these interventions, and all were home based. These included culturally tailored workbooks which contained illustrations of people of the same ethnicity as participants, reference to famous people of the same ethnicity who have asthma and could serve as role models, reference to stressors common to individuals of the given ethnic group, and addressing misconceptions and myths commonly held by people of the specific ethnic group.…”