The feasibility and acceptability of a home-visitation, asthma education program in a rural, Latino/a population

Objectives: The effectiveness of community health worker-delivered interventions to decrease environmental triggers for asthma in the home has been well documented in urban populations, but has had little evaluation in rural, Latino/a families. The purpose of this study was to evaluate the feasibility and acceptability of a home-visitation intervention designed to decrease environmental triggers for pediatric asthma in rural, Latino/a families.

Methods: Data from a large community health clinic's pediatric asthma program (2002, 2003, 2004, 2005, 2006) were used to retrospectively explore associations between program participation and asthma-related health outcomes. Demographic data were collected on 866 patients. Behavioral outcomes were evaluated in 374 participants. A medical record abstraction was conducted in a subsample of 400 patients to evaluate asthma-related urgent care use. Nonparametric tests were used to compare outcomes before and after the intervention. Demographic attributes associated with program participation were examined using logistic regression.

Results: Most (91%) participants were Hispanic, and 61% of participants' caregivers were either seasonal or migrant farmworkers. Over half (61%) of the participants did not complete the full intervention. A statistically significant improvement was found in caregivers' abilities to manage asthma medications and adopt behaviors to decrease triggers inside the home. Behaviors related to decreasing outside triggers did not significantly change. Asthma-related urgent care use significantly decreased; however, there was no association between intervention dose and a decrease in urgent care use. Demographic attributes were generally not associated with program completion, having baseline and exit data on intermediate outcomes, and/or inclusion in the chart review.

Conclusions: Results suggest that the asthma intervention helped caregivers improve the air quality in their homes and reduce urgent care admissions among pediatric participants. The intervention dose may be less important than taking part in an intervention to the extent feasible or desired by the family. Findings suggest that policy-level interventions need to address reimbursement for home visitation and environmental exposures that are beyond caregiver control, such as support for healthy and affordable housing in farmworker communities.