A Randomized Controlled Trial of Asthma Self-Management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers

The Seattle-King County Health Homes II Project

For asthmatic children living in low-income, multi-ethnic communities, adding home health visits by community health workers (CHWs) to in-clinic support from asthma nurses further increases the number of symptom-free days and also modestly improves quality of life for their caregivers.

Nearly 9 percent of U.S. children suffer from chronic asthma. In this randomized trial involving 309 children ages 3-13 living in low-income households in Seattle, all participating families received year-long individualized, self-management education and support from asthma nurses in clinics. The nurses also referred the patients to additional resources, such as school nurses and social workers. In addition, approximately half of the participants were randomly selected to receive visits from community health workers (CHWs). These CHWs were of the same ethnic background as the participants, had personal or family experience with asthma, and provided education, social support, advocacy and some simple home aids to reduce dust and allergens in the home.

Key Findings:

  • Children in both groups enjoyed significantly more symptom-free days after intervention; however, adding home health visits by CHWs added an additional 24 symptom-free days per year on average.
  • Caretakers for children in both groups had a better quality of life after intervention, but only caretakers in the “nurse plus CHW” group had a significant improvement, although it was slight.
  • Both groups increased their use of controller medications equally, suggesting the improvement for families visited by CHWs may come from efforts to reduce asthma triggers in the home.
  • Children in both groups used urgent health services less.
  • Caregiver race, ethnicity or level of education, and the children’s age or severity of asthma did not make a difference in the improvements.

Community health workers may be uniquely able to help families control their children’s asthma because CHWs have similar life and cultural experiences. The authors, however, suggest the best option may be to offer families asthma management support in a variety of ways since neither in-home nor in-clinic visits will fit all families’ needs.

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