Reducing Asthma Attacks in Disadvantaged School Children with Asthma - PROJECT SUMMARY/ABSTRACT
Our re-submission proposal, “Reducing Asthma Attacks in Disadvantaged School Children with
Asthma,” seeks broad-scale implementation of our effective school-based approach to improve asthma
disparities for children in low-income communities (ages 5 to 12 years). Using community-based participatory
methods with high risk populations and communities, we will contextualize dissemination and implementation
(D&I) of our Colorado school-based asthma program (Col-SBAP) that reduces asthma exacerbations and
missed school days, while also addressing social determinants of health (SDOH) which our pilot identified as
major drivers of asthma disparities. We will evaluate key metrics identified by diverse stakeholders during a
dissemination trial in rural and small metropolitan areas of Colorado. Our dissemination trial will include two
interventions: our evidence-based Col-SBAP and an evidence-based assessment and management approach
to key SDOH. Our pilot data show both interventions are critical to improve asthma disparities for children from
low income families. This two-step level of intervention, called Stop Asthma Attacks (SAA), will be designed for
sustainable delivery by school asthma navigators and school nurses who coordinate with primary care and
community resources. In partnership with our community stakeholders, the Exploration, Preparation,
Implementation, Sustainment (EPIS) D&I framework will be applied during the UG3 planning phase to
iteratively adapt our current implementation guide to tailored implementation plans that meet local community
and site-specific needs, resources and priorities (EPIS Phases 1 & 2). We will then conduct a UH3
dissemination trial with a randomized stepped-wedge study design in asthma “hot spot” school systems across
five Colorado regions to evaluate implementation strategies across asthma “hot spot” school systems (EPIS
phase 3, UH3 trial) and to apply the work from EPIS phases 1-3 to develop a “dissemination playbook” to
guide future program adoption by other school systems (EPIS Phase 4). The central hypothesis is that SAA will
have broad and equitable Reach (primary outcome), and yield important benefits in reducing asthma attacks
and symptoms, as compared to schools that have not yet implemented SAA. The SAA playbook will be
designed to promote the sustainable adoption of SAA, including training materials and a calculation of return
on investment. Our proposal is responsive to and addresses key elements of NHLBI HL-20-003 by “testing
late-stage (T4) implementation research strategies” and “promoting and improving population health in high-
burden communities” by using a public health approach to target “hot spot” schools with high levels of
uncontrolled asthma and asthma associated burden. This proposal will both include a rigorous stakeholder
engagement process to ensure SAA is disseminated to diverse geopolitical areas of Colorado with attention to
sustainability. Collectively, this evaluation and playbook will accelerate dissemination of SAA nationally to
communities experiencing health inequities in pediatric asthma care.
