Using home-based education to improve childhood asthma

According to the American Academy of Allergy Asthma & Immunology, childhood asthma is the most common serious chronic disease in infants and children. Although there is no cure for asthma, it can be managed with proper prevention and education. Controlling the symptoms of asthma in children is important in order to prevent long-term damage to growing lungs.

However, lack of education and lack of access to clinical care and health insurance are often barriers to controlling the symptoms. This is especially true among low-income communities in the Texas-Mexico border region where childhood asthma is a significant health issue.

One way to help educate these families who might lack access to asthma education is through home-based education from community health workers (CHWs).

A study led by Juha Baek, a doctoral student in the Department of Environmental and Occupational Health at the Texas A&M School of Public Health and a graduate research fellow in the Center for Outcomes Research at the Houston Methodist Research Institute, found that home-based education provided by CHWs effectively improved health outcomes among children in communities lacking access to medical resources.

For the study, which was recently published in BMC Public Health, Baek and his cohorts chose to focus on Hidalgo County in the Rio Grande Valley of Texas. In 2017, Hidalgo County had a population of about 860,000 residents, with 92.2 percent of the population identifying as Hispanic. Additionally, the prevalence of childhood asthma was 9.4 percent, which was higher than the national (8.3 percent) and state (7.6 percent) averages.

“This area has a very high rate of childhood asthma and is very in need of asthma education,” Baek said.

Nearly 300 children and their families, of whom 97 percent were Hispanic, were separated into two groups: an intervention group that received educational materials and face-to-face meetings with a CHW at home and a control group that only received educational materials. Families in both groups were also given allergen-proof mattresses and pillow cases.

While there have been previous studies on the effects of home-based education, Baek said his team’s approach was unique in that it compared the changes of health outcomes between an intervention group and a control group.

“This is a more effective way to see the effects of intervention rather than using just the one group,” Baek said. “It is better to compare the groups to see the effect of the educational intervention on the children and their families.”

The intervention group was provided home-based asthma education based on the Asthma and Healthy Homes curriculum certified by the Texas Department of State Health Services. The goal was to teach the families how to more effectively manage their children’s asthma and create healthier home environments.

The plan, which was led by CHWs, referenced the Asthma and Healthy homes curriculum and contents of the Seven Principles of Healthy Homes. The components included: asthma signs and symptoms, asthma management, identifying common asthma triggers, correct use of asthma medications, emergency actions in case of asthma attacks, and fundamental components of an asthma action plan.

From their results, Baek and his team concluded that home-based education by CHWs from the local area had a significant effect on the improvement of health outcomes—including the number of asthma attacks and a family’s emotional health—among children in communities lacking access to medical resources. Since the CHWs were from the area, they spoke the language and knew the culture, which in turn helped to put the families at ease. The researchers mentioned that expanding such programs in low-income communities could help address health disparities and improve the health outcomes of children with asthma.

“The families felt cared for and emotionally supported because it was in their home and the CHWs spoke their language and knew their culture,” Baek said. “For the children’s asthma control and management, the families are very important and they should be educated on how to care for their children.”

Baek’s co-authors on the study include: from School of Public Health, Genny Carrillo, MD, ScD, director of the Program on Asthma Research and Education and associate professor; Xiaohui Xu, PhD, head of the Department of Epidemiology and Biostatistics, and associate professor; Lucia Conner, MPH, CHWI, program coordinator of the Program on Asthma Research and Education, McAllen Campus. And Niko Tapangan from the Hidalgo County Health and Human Services Department; Ke Huang, graduate student in the Texas A&M University Department of Statistics.