Table 1 Intervention components, their descriptions, and local adaptations
Component | Description | Adaptations |
|---|---|---|
Case management and follow-up delivered by trained nurse educators | • Personalized case management approach addressing specific needs of family/child • Monthly home visits • Patient navigation for preventive health services and follow-up • Regular check-ins by cell phone or text message with feedback on medication use | Methods: • Piloting of case management approach with caregivers and children • Expert review by local physicians Adaptations: • Modeled in part on the PROFAN program |
Interactive asthma education sessions | Based on NHLBI “Breath of Life” curriculum including flipcharts, question and answers, videos, and other interactive learning activities • Asthma pathophysiology • Symptom recognition • Common treatments and medications • Trigger abatement • Motivation | Methods: • Piloting of education sessions with caregivers and children • Focus groups with caregivers • Expert review by local physicians Adaptations: • Reinforcement of key concepts over six home visits • Addition of complementary video components |
“Súper Niño” comic book-style educational booklet | • Reinforces basic asthma education concepts in shorter, simpler format for children • Story format – walks children through the four tools (definition, cause, treatment, action plan) they need to manage their asthma and become a “super niño” • Reinforcement of self-efficacy and positive messaging – “Armed with these tools, I can lead a healthy, active life” | Methods: • One-month pilot with 10 children and caregivers Adaptations: • Developed by nurse educator exclusively for the Peruvian context. • Coloring book encourages younger children to engage with booklet outside of home visits |
Hands-on instruction of inhaler use | • Delivered by nurse managers in the home context • Demonstration by nurse manager followed by hands-on practice by child and caregiver • Feedback and problem solving by nurse manager • Technique reinforcement provided at subsequent visits | Methods: • Consultation with local pediatric pulmonologists. • Follows Spanish aerosol therapy guidelines [12] Adaptations: • In line with local clinical practice standards and available equipment (spacers, etc.) |
Locally adapted asthma action plan | • Personalized medication regimen in accordance with physician instructions • Illustrated guidance on symptom recognition and identifying “green, yellow, red” zones • Simple instructions for taking appropriate action based on zones • Includes medication diary to keep track of use of daily inhaled (preventive) medications | Methods: • Interviews and focus groups with physicians, nurses, caregivers, children Adaptations: • Simple and clear language • Bright and dynamic illustrations • Concordance with local clinical standards for care seeking |
“AsmaCard” | • Unified record of clinic visits, ED visits, hospitalizations for asthma, personal triggers • ACT Questionnaire • Graph of ACT scores over time • Illustrated instructions for proper inhaler technique | Methods: • Interviews and focus groups with physicians, nurses, caregivers, children Adaptations: • Simple and clear language • Bright and dynamic illustrations • Concordance with local clinical standards for care seeking |