328 - Using a rapid qualitative approach to inform iterative planning and adaptation of a school-based asthma program

Publication Number: 328.6760

Julia Reedy, University of Colorado School of Medicine, Aurora, CO, United States; Avery C. Schaefer, ACCORDS, Broomfield, CO, United States; Amy G. Huebschmann, University of Colorado School of Medicine, Aurora, CO, United States; Nicole Wagner, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Stanley Szefler, University of Colorado School of Medicine, Aurora, CO, United States; Lisa Cicutto, University of Colorado School of Medicine; National Jewish Health, Denver, CO, United States; Sarah Brewer, University of Colorado School of Medicine, Aurora, CO, United States

Background: Asthma is a prevalent chronic pediatric condition associated with significant health disparities. The Better Asthma Control for Kids (BACK) program aims to address and reduce asthma disparities and improve asthma control for children. BACK is a school-based asthma program utilizing an asthma navigator to support school nurse identification and management of students with poorly controlled asthma, asthma care coordination, and education for students and their families.

Objective: To evaluate implementation from multiple program partner and participant perspectives from the inaugural year of a 4-year trial of the BACK program in four high-need urban and rural regions of Colorado to inform adaptations and iteration planning for subsequent years.

Design/Methods: We conducted in-depth, individual semi-structured interviews with key individuals involved in the BACK program including school nurses (Dec 2023- Jan 2024), asthma navigators (May-June 2024), and caregivers of students with asthma (June 2024). These interviews, informed by the Practical Robust, Implementation, and Sustainability Model (PRISM), gathered perspectives, feedback, and recommendations about the BACK program to inform program adaptations and subsequent iterations. We applied a rapid qualitative analytic approach to support real-time iterative adaptation planning.

Results: Participants (n=39) included 6 asthma navigators, 17 school nurses, and 16 caregivers. Across roles, participants’ perspectives of the BACK program were positive with all identifying perceived or anticipated program benefits for students with asthma and their families. Participants described three primary challenges with the first year of the program and provided recommendations on how these could be improved in subsequent years. These challenges included: 1) limited school nurse engagement and communication influenced misunderstandings of BACK; 2) Difficulties with identification, documentation, and enrollment of students with asthma at the beginning of the school year; and 3) Program scope misalign with school context (see Table).

Conclusion(s): Identifying key challenges and considering recommendations from caregivers, navigators, and school nurses to mitigate these have allowed the research team to develop targeted adaptations to support the Year 2 implementation of BACK. Engaging participants that represent program deliverers and recipients provides comprehensive feedback on how best to support and improve program delivery and confer the greatest benefit to caregiver and student program participants.

Key Findings and Illustrative Quotations
Implementation Y1 PAS table.pdf