Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas
Abstract
:1. Introduction
2. Materials and Methods
2.1. Procedures
2.2. Participants
2.3. Assessment and Measures
- How is the program promoting positive behaviors toward asthma among affected individuals? (Probes: Do you know about the CLEAR program and/or can you provide any information to me about this program? Explain what you mean; what services, which behaviors? How are health inequities addressed?)
- How is the program being implemented? (Probes: Detail program successes and areas for improvement; ask for examples and specifics/details)
- What are successful strategies for sustainability in services provided by the home environment intervention program? (Probes: Please provide an example; please add more information)
- What are challenges for sustainability in each service provided by CLEAR and/or environmental interventions from Children’s Hospital? (Probes: Please provide an example; please add more information)
- What are successful interventions of the CLEAR program? Why? (Probes: Please provide an example, can you explain? Are any interventions addressing health disparities? If yes, how?)
- Which interventions of the CLEAR program are difficult to implement? Why? (Probes: What could be altered or adjusted to make these interventions more easily implemented?)
- In your opinion what are the challenges in persuading families to accept and follow through with the referral process of the program? (Probes: Please provide an example; please add more information)
- Are there any budget constraints or financial barriers that inhibit CLEAR from operating and/or expanding services? (Probes: Ask for a specific example and further details)
3. Results
“The CLEAR program really focuses on those patients and families that have an environmental risk like rodents or roaches, or mold and mildew, you know things that aren’t up to code and I think that the way we screen, at least in the inpatient setting for the social determinants can be really enlightening for the residents in terms of knowing more about their patients and their families and what they are being affected by at any given time.”
“I think that there’s a variety of other reasons why families might be hesitant to engage with the CLEAR program or home health or other programs that require outreach to them in their home setting… They are often very hesitant to provide information about where they live, give correct information about where they live, and follow up with people even via phone, let alone having someone come to their home.”
“Well when you have the situation whether it be the roaches, the mold, the mice, situations abated and removed from the living area, the apartment, the townhome… I am assuming that it helps with the asthma conditions of the child, but as far as us, anytime we can get abatement is a huge success for us.”
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Category | Theme | Number Endorsing Theme | Representative Quotes |
---|---|---|---|
Successful strategies for sustainability | The CLEAR program is a way to keep the home environment on the radar of health professionals | 5 | Interview 2: “We might know from the family their concern is mold or their concern is fire damage, but we may not. So I don’t know after it gets out of my hands as the physician what the next steps are.” Interview 4: “I think that having a program that allows families to receive assistance to help them do things to their home environment that they wouldn’t otherwise be able to do, and that’s keeping their child out of the hospital hopefully.” |
Patient feedback would show physicians that the program is working | 4 | Interview 2: “I think if you have positive patient outcomes that’s probably your best strategy for continued support of the program and continue to have physicians and nurse practitioners to want to use the program is when they see it benefits their patients.” Interview 8: “I don’t have the numbers about how many the health department actually goes out and talks to them, are people letting them in?” data | |
Challenges for sustainability | There are communication issues between parents and the health department that prevent them from connecting | 5 | Interview 1: “The challenges are making good contact with the guardian or the parent and even if contacting and inspection is made, having them be willing to coordinate a re-inspection and stay in the same unit is sometimes a challenge.” Interview 3: “We find families are hesitant to let somebody into their home. Whether they just don’t feel comfortable, or sometimes they are hiding something. The other thing is that sometimes it may not fully be explained to them why this program is here and why it’s implemented on certain homes.” Interview 4: “I think something that we are not always as good about as we should be is making sure that we have a reliable means to communicate with the family once they leave and it’s often sometimes as simple as we don’t have a reliable phone number, there phone number is changed, or their phone number gets turned off, or their voicemail box is full.” Interview 5: “I think there may be some concern about backlash from landlords if the health department comes in, you know they may have some fear around being evicted or are some negative consequences of them allowing this to happen and so I think those are the things that I think the families probably worry about.” |
Mistrust and fear make it difficult to connect with parents | 7 | Interview 2: “Families are often concerned about feeling like people are checking up on them.” Interview 3: “We find families are hesitant to let somebody into their home. Whether they just don’t feel comfortable, or sometimes they are hiding something. The other thing is that sometimes it may not fully be explained to them why this program is here and why it’s implemented on certain homes.” Interview 5: “I think there may be some concern about backlash from landlords if the health department comes in, you know they may have some fear around being evicted or are some negative consequences of them allowing this to happen and so I think those are the things that I think the families probably worry about.” |
Category | Theme | Number Endorsing Theme | Representative Quotes |
---|---|---|---|
Successful interventions of the CLEAR program | CLEAR can help address health disparities, get home services and home improvements for families in need | 5 | Interview 5: “Neighborhoods and the place they live can be a contributing factor to their asthma, I think the CLEAR program really helps us figure out what families need help and it allows us to address those needs sooner rather than later” Interview 7: “I think it essentially offers a service to help eradicate some of the household triggers that otherwise would not be available to any of our patients.” |
The program can help provide knowledge and resources to address mold and pests in the home data | 6 | Interview 5: “The CLEAR program is just a standardized way to get families the help they need for addressing things like mold and cockroaches, etc. or other environmental factors that might be contributing to their kids worsening asthma.” |
Category | Theme | Number Endorsing Theme | Representative Quotes |
---|---|---|---|
Challenges in persuading families to accept and follow through with the referral process | Parents feel guilty or embarrassed that their home is impacting their child’s health | 6 | Interview 4: “I think that families feel responsibility and feel guilty about their child having health consequences because of that and feel embarrassed about that, and therefore may be hesitant to engage with people outside the hospital coming into their home and seeing things like that.” Interview 7: “People are just not interested in having other folks out to their homes, whether that’s the concern about being judged or what I can’t say.” |
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Workman, B.; Beck, A.F.; Newman, N.C.; Nabors, L. Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas. Int. J. Environ. Res. Public Health 2022, 19, 172. https://doi.org/10.3390/ijerph19010172
Workman B, Beck AF, Newman NC, Nabors L. Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas. International Journal of Environmental Research and Public Health. 2022; 19(1):172. https://doi.org/10.3390/ijerph19010172
Chicago/Turabian StyleWorkman, Brandon, Andrew F. Beck, Nicholas C. Newman, and Laura Nabors. 2022. "Evaluation of a Program to Reduce Home Environment Risks for Children with Asthma Residing in Urban Areas" International Journal of Environmental Research and Public Health 19, no. 1: 172. https://doi.org/10.3390/ijerph19010172