Background: Eight percent of school-age children (5-17 years) have asthma, with African American (AA) children, predominantly those living in the southeastern United States, bearing a disproportionate burden (14.25%). The PCORI ASIST study compared two ways of controlling mild persistent asthma symptoms among AA children and found similar results between symptom-based inhaler adjustment and healthcare provider (HCP)-based prescribed daily inhaler use – this has implications for equitable care provided to these children.
School nurses (SN) are integral to achieving health equity for students at the individual and systems levels, including understanding the disparate use of prescribed medications by racial and ethnic minority students. Equipped with knowledge about the PCORI ASIST study results, SNs can identify at-risk students (specifically at-risk AA students) and their families and educate them about this evidence and how to talk with HCPs to explore this treatment option.
Proposed Solution to the Problem: The National Association of School Nurses (NASN) will disseminate PCORI’s ASIST Study’s results along with the Evidence Updates for families and SNs. NASN’s dissemination will include: (1) a national strategy to actively disseminate PCORI research findings; (2) targeted work with four states (Florida, Georgia, Ohio, and North Carolina) to understand opportunities and challenges in implementing research findings and inform development of professional development (PD) and dissemination strategies and; (3) a national virtual convening of key stakeholders including SNs, HCPs, parents/caregivers, and students to identify opportunities for collaboration to increase dissemination and implementation of this evidence update.
Objectives: This project’s objectives are: (1) to increase SN awareness of the Evidence Update for treating mild persistent asthma in children, particularly for AA students; (2) to increase use of PCORI’s Evidence Update in school nursing practice to promote health equity for AA students with mild persistent asthma; and (3) to demonstrate effectiveness of collaboration among key pediatric asthma stakeholders.
Activities: Commencing in January 2023, Year 1 activities will include conducting the national dissemination of the research findings via NASN’s proven communication channels and a PD offering. A Needs Assessment in the target four states will be done to identify school districts where focused dissemination and education can take place, and the Roundtable Convening. Year 2’s activities include the second PD offering at NASN’s annual conference, focus group debriefs with the convening participants and the target state SNs, a podcast series, and an article submission for consideration to publish to the NASN School Nurse journal.
Projected Outcomes and Outputs:
Short-term outcomes during the project period include: (1) increased awareness of the PCORI Evidence Update for treating mild persistent asthma in AA children by SNs, students, and families and (2) implemented PD events for SNs on asthma care coordination incorporating the PCORI Evidence Update.
Medium-term outcomes (0-2 years post-project period) include: (1) strengthened collaboration among SNs and key pediatric asthma stakeholders to address health equity for students with mild persistent asthma and (2) increased dissemination of PCORI Evidence Updates using multiple pediatric asthma stakeholder communication channels.
Long-term outcomes (3+ years post-project period) include: (1) increased confidence and ability of SNs to reach parents/caregivers and students for student-centered asthma care and (2) expanded and updated school-based asthma management programming for students with mild persistent asthma.
These outcomes will protect the health and safety of all students with asthma, and advance health equity while also supporting their educational experience. The outputs and deliverables from this project include the enduring PD, available to SNs for three years, and the podcast series.
Patient and Stakeholder Engagement Plan: NASN has received Letters of Commitment for the Convening from the American Academy of Pediatrics; the American Academy of Allergy, Asthma, and Immunology; and the National Association of Pediatric Nurse Practitioners, as well as a commitment to participate from an SN asthma care coordination expert from North Carolina with experience in addressing high asthma prevalence rates in AA children and a Georgia SN leader to facilitate the convening. Also included will be two parents to provide parent perspectives on the new research and the video testimony of two or three students/children with asthma to provide firsthand information on their experience living with asthma and their current medication usage, as well as any challenges/struggles with their medication. These stakeholders will be key collaborators in this initiative.