PURPOSE: The Brooklyn Asthma Project/Brownsville and East New York (BAP/BENY)was a one year study that began in September, 2008 to assess the impact of asthma education on asthma management and control in preschool children. Despite our experience in the daycare population and nine months of planning, unexpected problems and pitfalls significantly affected successful completion of the project.
METHODS: Children with asthma were identified via a Brief Respiratory Questionnaire (BRQ) in 20 Brooklyn daycare centers. Asthma education included monthly sessions by an asthma educator for daycare staff and parents of children with positive BRQs, and a software program for daycare staff. A parental survey was administered initially and after 6 months of interventions to assess asthma-health status in the children with positive BRQs.
RESULTS: There was improvement in parental comfort in managing children’s asthma and trends toward more consistent use of asthma medications, but we failed to show impact of asthma education on key outcomes (symptom frequency, urgent care visits, hospitalizations). Grant support permitted only 1.25 FTEs (asthma educators) to oversee the project. We had to rely on center staff to administer and collect consents, BRQs and parental surveys. Despite incentives for both parents and daycare staff, pre-intervention parental surveys were completed in only 257/333 (77.2%) of children screening positive for asthma, and even fewer, 193/333 (58%) post-intervention. Centers were slow to collect data which impacted our ability to provide educational interventions according to schedule. Education events averaged 4.2 per center rather than 8 planned. Reduced daycare funding resulted in declining enrollment during the study. Additionally, there was frequent withdrawal of children participating in the study due to family relocation and other social issues.
CONCLUSION: We over-estimated our ability to achieve meaningful cooperation from daycare staff despite their initial enthusiasm and understanding of the importance of improving asthma care in this population.
CLINICAL IMPLICATIONS: Future studies to assess outcomes of asthma education in children attending daycare may benefit from our experience.
DISCLOSURE: Kathy Garrett-Szymanski, Grant monies (from sources other than industry) New York Community Trust; Grant monies (from industry related sources) Affinity Health Plan, Making a World of Difference; No Product/Research Disclosure Information