The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Abstract

Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

“…Using service user researchers to undertake site engagement and data collection aspects of research reduces the power differential between 'expert' researcher and study participant roles. It has been suggested that this increases the credibility of the project, 32 puts qualitative interview participants at ease and enables honest and candid explanations of issues discussed. 33 In this study, as service user researchers were employed on the basis of their lived experience of mental health problems, there was the added advantage of the researchers having rich understanding and experience of the issues which participants raised and discussed.…”

Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle

“…The effectiveness of the intervention was shown in a population of low-income children with asthma recruited from across urban King County, including Seattle. Study participants were similar to those who did not enroll (Krieger et al, manuscript under review) and the intervention itself was performed by community members in a field setting similar to what would be feasible in a clinical setting given adequate resources for such outreach activity (Krieger et al, 2002). The approach may therefore have generalizability to similar low-income urban populations.…”

“…The Seattle-King County Healthy Homes Project (SKCHH) is a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens, irritants, and toxicants in the home described in more detail by Krieger et al (2002). We randomly assigned 274 low-income children with asthma aged 4-12 years to either a higher-or lower-intensity intervention group.…”

“…At 1 year after joining, low-intensity group participants received the full package of resources and additional advice to address remaining indoor environmental quality concerns. Details of the CHWs training and intervention have been described previously (Krieger et al, 2002).…”

Healthy Homes University: A Home-Based Environmental Intervention and Education Program for Families with Pediatric Asthma in Michigan

“…The survey captured demographic information; family history of asthma; knowledge and presence of asthma triggers; home cleaning frequency; and the subject child's asthma symptoms, frequency of medical visits for asthma, and asthma medication usage. Staff designed the baseline questionnaire using the following nationally recognized assessment tools: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Child Asthma Call-Back Survey Questionnaire, 22 the Seattle-King County Healthy Homes Project Bimonthly Interim Questionnaire, 12 and the ZAP Asthma Project Caregiver Asthma Knowledge Survey Instrument. 23 While the survey was being conducted, the basic intervention products ( Figure 3) were installed.…”