Engaging Regional Stakeholders to Identify Priority Outcomes of Success for a School-based Asthma Management Program

ANDREA JIMENEZ-ZAMBRANO, PhD, MPH
ACCORDS

Asthma is a common chronic disease for children that disproportionately impacts low-income families. Our school-based asthma management program focused in urban, low-income schools, has reduced health care utilization and school absences through active management of asthma and social determinants of health (SDOH). As part of scaling this program to 5 new Colorado regions, we engaged regional Community Advisory Boards (CABs) to identify priority outcomes of success.

The CABs, formed in 5 underserved regions with higher SDOH needs, have 39 members that include school nurses, health care providers, parents of children with asthma, and SDOH agency leads.

Each CAB meets quarterly with our team to develop and guide program planning. Using a two-step nominal group differences technique (NGDT) process, each CAB identified outcomes of success for managing asthma in 4 distinct categories: 1) schools, 2) child/family, 3) health care provider, and 4) community SDOH agencies. Step one of our NGDT process identified candidate outcomes of success themes through brainstorming and dialogue with CAB members. In step two, candidate outcomes were reviewed and discussed, followed by each CAB member confidentially voting on their top 2 priority outcomes of success in each of the 4 categories – this led to each of the 5 CABs ranking their top 2-3 priority outcomes in each category.

Priority outcomes of success selected by the highest number of regional CABs are listed, by category:

• Child/family: well-controlled asthma (2 regions); accurate inhaler technique (2 regions); multiple outcomes prioritized in one region, including reduced school absenteeism and ED visits
• School: increased school asthma care plan on-file early in school year (4 regions); increased connection between schools and health care providers (4 regions) Health provider: school asthma care plan completed by provider early in school year without school nurse prompting (3 regions); improved use of asthma follow-up care – shift from reactive episodic to preventive/routine follow-up (4 regions)
• SDOH: address health literacy needs for parents/family (3 regions); transportation resources (3 regions); availability of fun, low-literacy, educational resources (e.g., fun how-to-use inhaler resources for children) (2 regions)

The highest priority outcomes of success identified include health outcomes related to well controlled asthma (including reduced urgent care use and school absenteeism), process outcomes (e.g., accurate inhaler technique; inhalers/care plans in schools), and health equity-focused outcomes related to transportation and health literacy. Our NGDT process to prioritize outcomes of success has informed our context-driven implementation strategy selection and the study outcomes we will track/report back to CABs. This process may be replicated for other studies.