Mixed methods evaluation of Asthma Link implementation: A community-clinical linkage intervention of school supervised asthma therapy

Abstract

Background: Asthma Link is a community-clinical linkage intervention wherein children with poorly controlled asthma receive school-supervised asthma therapy. This intervention supports collaboration between medical providers who identify and enroll children, families who consent and bring medications to their child’s school, and school nurses who supervise daily preventive medication administration. This intervention has shown promise in reducing asthma exacerbations, however implementation outcomes (adoption and acceptability), have not previously been assessed.

Methods: Using mixed-methods, we assessed adoption (defined as uptake of multiple process steps leading to children receiving supervised preventive asthma medication at school) and acceptability of Asthma Link. We generated descriptive statistics from surveys with practice staff(n=8), parents of enrolled children(n=29), and school nurses(n=14), as well as data tracking logs. We also interviewed medical providers and staff(n=8) and used rapid qualitative analysis. Finally, we triangulated qualitative and quantitative findings.

Findings: Regarding adoption, first, 100% of trained providers offered the program. Providers identified 66 eligible children and enrolled 47%(n=31). The preventive asthma medication was brought into school an average of 2.6 (SD=2.9) weeks after enrollment and medication was available to students for 95% of the time they were in school over twelve months of enrollment. One medical provider reflected on adoption: “It’s not for lack of trying...but the family is not willing to.” Acceptability was high in surveys and interviews: 77% of providers, 78% of parents, and 79% of school nurses strongly agreed that the program was acceptable. One provider reported “It was an excellent, excellent program.”

Implications for D&I Research: We found excellent adoption of Asthma Link once children were enrolled and high acceptability of the intervention. Qualitative interviews provided important context to quantitative implementation data and will inform future adaptations to promote intervention uptake. For example, we will develop implementation strategies to better support parents, who are identified by providers as “not willing” to participate, which could increase adoption. The use of mixed-methods to assess implementation outcomes at the level of intervention deliverers (medical providers, practice staff, school nurses) and end-users (parents) provided nuanced, actionable information on implementation. This approach should be considered in future implementation evaluations.