A Patient-Centered Asthma Management Communication Intervention for Rural Latino Children: Protocol for a Waiting-List Randomized Controlled Trial

Robin M Dawson, Sue P Heiney, DeAnne Hilfinger Messias, Dennis Ownby, Robin M Dawson, Sue P Heiney, DeAnne Hilfinger Messias, Dennis Ownby

Abstract

Background: Rural Latino children with asthma suffer high rates of uncontrolled asthma symptoms, emergency department visits, and repeat hospitalizations. This vulnerable population must negotiate micro- and macrolevel challenges that impact asthma management, including language barriers, primary care access, parental time off from work, insurance coverage, distance from specialty sites, and documentation status. There are few proven interventions that address asthma management embedded within this unique context.

Objective: Using a bio-ecological approach, we will determine the feasibility of a patient-centered collaborative program between rural Latino children with asthma and their families, school-based nursing programs, and primary care providers, facilitated by the use of a smartphone-based mobile app with a Spanish-language interface. We hypothesize that improving communication through a collaborative, patient-centered intervention will improve asthma management, empower the patient and family, decrease outcome disparities, and decrease direct and indirect costs.

Methods: The specific aims of this study include the following: (1) Aim 1: produce and validate a Spanish translation of an existing asthma management app and evaluate its usability with Latino parents of children with asthma, (2) Aim 2: develop and evaluate a triadic, patient-centered asthma intervention preliminary protocol, facilitated by the bilingual mobile app validated in Aim 1, and (3) Aim 3: investigate the feasibility of the patient-centered asthma intervention from Aim 2 using a waiting-list randomized controlled trial (RCT) to investigate the effects of the intervention on school days missed and medication adherence.

Results: Mobile app translation, initial usability testing, and app software refinement were completed in 2019. Analysis is in progress. Preliminary protocol testing is underway; we anticipate that the waiting-list RCT, using the refined protocol developed in Aim 2, will commence in fall 2020.

Conclusions: Tailored, technology-based solutions have the potential to successfully address issues affecting asthma management, including communication barriers, accessibility issues, medication adherence, and suboptimal technological interventions.

Trial registration: ClinicalTrials.gov NCT04633018; https://www.clinicaltrials.gov/ct2/show/NCT04633018.

International registered report identifier (irrid): DERR1-10.2196/18977.

Keywords: Latino; RCT; asthma; family-centered care; mHealth; mobile app; mobile phone; pediatrics; rural health; school nursing.

Conflict of interest statement

Conflicts of Interest: None declared.

©Robin M Dawson, Sue P Heiney, DeAnne Hilfinger Messias, Dennis Ownby. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 01.12.2020.

Figures

Figure 1
Figure 1
Systematic translation process of an existing asthma management app. PI: principal investigator.
Figure 2
Figure 2
Preliminary protocol. ED: emergency department; NHLBI: National Heart, Lung, and Blood Institute; PCP: primary care provider.

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