Dissemination and Implementation of School-Based Asthma Initiatives: The Asthma 411 Pilot

Aryal, Subhash
Allsopp, Leslie C.
Sterling, David
Spence-Almaguer, Emily
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Purpose: The dissemination and implementation (D&I) of evidence based practices (EBIs) has been identified as one of the most critical barriers to improvement of the public’s health. The Asthma 411 EBI was developed, implemented and evaluated in St. Louis, MO from 2002-2008; Asthma 411 was disseminated, adapted, and piloted in Fort Worth, TX from 2013-2015. The evaluation of the pilot was designed to examine processes and outcomes of the program’s dissemination, inform ongoing expansion, and identify approaches that may support dissemination of other school health EBIs. Methods: In 2013, an engaged process was used to retain core components of Asthma 411 while adapting peripheral program elements. The pilot was implemented in one elementary (n=567) and 1 middle school (n=791). Three service categories were included: 1) access to rescue medication through standing orders; 2) support for enhanced school asthma services; and 3) support for communication with parents and health care providers to support comprehensive, prevention oriented care. Data collected included 1) school day EMS calls one year prior and both years of the program, 2) logs of aggregated nursing services, 3) individual level school absence and demographic data, 4) availability of medication provided through existing policies, and 5) informal interviews. Results: The pilot was positively received by schools and parents. During the pre-implementation year, there were 19 asthma-related EMS calls from the pilot schools. During the two years of the pilot, school day, asthma-related EMS calls were eliminated. Across the two year study, there was an increase in documented asthma self-management education, use of Asthma Control Tests, proportion of students with asthma that have authorization for rescue medication, and documented efforts to communicate with parents and health providers. Evaluation of absences was limited by the lack of pre-implementation data, small numbers, large variance, and short duration. Between year 1 and year 2, the gap between unadjusted, weighted absences among students with and without asthma was reduced 1.1 day. However, this difference was not seen in a fully adjusted negative, binomial regression analysis which provided a modeled mean difference of 1.28 absence days between children with and without asthma (95%CI 1.10, 1.50, p = .002) during year one, and 1.24 days (95% CI 1.07, 1.47, p = .006) in year two. Conclusions: The Asthma 411 case study identifies important characteristics of interventions, interventionists, contextual factors, and processes that may support effective dissemination of school based health initiatives. More research is needed to clarify impacts on absenteeism, and to determine if observed benefits are sustained.