Development and Pilot Randomized Trial of a Coping Skills Intervention for Low-SES Latinx Families of Children with Asthma.

Objective: Psychosocial stress contributes to asthma disparities for low-SES Latinx children, but primary and secondary control coping by children and parents is associated with better psychosocial and asthma outcomes. Therefore, we developed and pilot tested Adapt 2 Asthma (A2A), a family-based coping and asthma self-management intervention for low-SES Latinx families. Methods: Children, parents, and primary care providers (N=16) participated in five focus groups to refine A2A's content and delivery. Subsequently, families of children ages 9-12 with asthma (N=24) were recruited from primary care clinics and randomly assigned to receive A2A or enhanced usual care (EUC). Results: Based on focus groups, A2A was refined to address feasibility, Latinx-specific cultural factors, and provider-family gaps. Results of the pilot RCT showed that 92% of families completed all sessions of A2A, and there were high levels of satisfaction with and fidelity to A2A. There were no statistically significant differences between the A2A and EUC groups at 3-month follow-up, although there were small, non-significant effects favoring A2A on parent-reported asthma control, parent secondary control coping, and emergency department visits. Conclusions: We found evidence of acceptability, feasibility, and potential benefits of A2A for low-SES Latinx families. Findings provide guidance for future implementation in primary care.

Exploring low-income African American and Latinx caregiver perspectives on asthma control in their children and reactions to messaging materials.

BACKGROUND: African-American and Latinx children suffer from higher rates of uncontrolled asthma and poorer outcomes compared to white children. Sociocultural factors play a prominent role in how caregivers navigate asthma control for their children. OBJECTIVES: (1) Explore the knowledge, perceptions and behaviors of Latinx and African-American caregivers related to their children's asthma and identify barriers to achieving asthma control; and (2) Elicit caregiver responses to messaging materials intended to help them better recognize uncontrolled asthma and seek timely medical treatment. METHODS: Study participants were recruited and screened to meet the following inclusion criteria: African-American or Latinx race/ethnicity, household income at or below 185% of the federal poverty line, and at least one child diagnosed with asthma with symptom frequency consistent with uncontrolled asthma according to national guidelines. Participants attended one of three moderator-led focus groups. The transcripts were qualitatively analyzed using a thematic analysis approach. RESULTS: Themes emerged among the nineteen participants related to asthma assessment, management, emotion, support, and trust. Caregivers exhibited gaps in their asthma knowledge, especially pertaining to the term "asthma control." Caregivers generally worried about asthma emergencies more than the daily impairments caused by uncontrolled asthma. Many were uncomfortable using daily controller medications, citing issues of provider trust and side effect concerns. Caregivers did not recognize uncontrolled asthma in their own child, even after viewing messaging materials informing them of symptom frequency criteria. CONCLUSION: Culturally tailored interventions, including public asthma messaging, should address low trust in provider recommendations and caregiver concerns about controller medications.