Running head: PLANNING INTERVENTION

Asthma Control and Education in Long Beach (ACE-LB)

Harry Ta (Lead)

Jorge Guerrero

Jason Levalle

Imani Moses

Val Macias

CSULB
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Implementation Plan

Program Model Theory

The program planning model that will be used in our program is the MAP-IT model. This

model consists of five components that clearly outline the steps that need to be taken in order to

develop a program that will self-empower the target population and ensure the positive change

will be sustained after the program ends. The first component involves mobilizing individuals

and organizations. Meeting with local Community-Based Organizations will occur in order to

reach our target population. Forming this coalition with current existing organizations will build

a trust within the community that will then be used to help them with the burden of asthma. A

partnership will also be made with St. Mary Medical Center, the primary hospital in the target

geographic area. Patients who get seen for asthma related complications will be referred to our

program Asthma Control and Education in Long Beach, ACE-LB for short. The second

component is to assess the areas of greatest need in our community. Asthma rates tend to be

higher in lower socioeconomic neighborhoods with poor air quality (Environmental Protection

Agency, 2016). African Americans and Hispanics have higher rates of emergency room visits

related to asthma (Center for Disease Control and Prevention, 2016). Long Beach, CA was

chosen for ACE-LB since it has a significant Hispanic and African American population, areas of

low socioeconomic status, and the ports nearby which cause poor air quality. The third

component is to plan our approach. Interviewing the Director of Community Engagement, Victor

Ortiz-Luis, gave insight on past techniques that have shown promise in tackling the burden of

Asthma. Home visits are going to be the main intervention of ACE-LB since there have been

programs in Long Beach that have used this method and have shown promise. The fourth

component is to implement our plan using concrete action steps. A major step that needs to occur
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in this component is having all community health workers trained on how to effectively conduct

the home visitations. These workers will also be trained on how to properly teach the asthma

education classes. Outlines indicating our goals and assignments that need to be completed for

our program participants will also used to assure that everyone is receiving the same treatment.

The last and extremely important component is to track our progress over time. In order to

ensure that resources are being well spent and our program is reaching its objectives, we will

have an outside evaluator checking the progress over time. Surveys and interviews will be given

to the participants two times after the initial visit as well as one year after the program has come

to an end to determine whether or not they have gone back to the emergency room due to asthma

which is the overall goal of the program.

Behavioral Model

Our program is built on the framework of the Health Belief Model which focuses on

behavior at the individual level. Emergency related asthma attacks are directly affected by

asthma participants who fail to take the proper steps to prevent asthma related flare-ups which is

solely based on the individual's thought process on how to take the proper health-related action.

The health belief model identifies that when a person realizes they are susceptible to a condition

that has a serious consequence, it is in there best interest to gain knowledge on how to move

forward in maintaining the problem. The seven components to the health belief model are, 1)

perceived susceptibility-beliefs about the persons likelihood of having the problem, 2) perceived

severity- beliefs about how serious the health problem is and its consequences, 3) perceived

threat- overall perception of threat to health, 4) perceived benefits of an action- belief about the

benefits of action to reduce a health threat, 5) perceived barriers to take the action- overall

perception of threat to health, 6) cues to action- information about perceived threat, benefits,
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barriers of particular actions and 7) self-efficacy- ones ability to take specific action. This

individual thought process can help prevent severe asthma related attacks and it can also help

patients control their asthma.

Overall Intervention

Reducing asthma attack rates for the desired target population can be achieved through

conducting proper asthma education, demonstrating proper inhaler use, and conducting a house

inspection during a home visit. The three activities will be implemented during each home visit

regarding asthma and how to manage it. There will be a total of three home visits during the

program. The first home visit will contain the bulk of the information and detailed

demonstrations while the subsequent two will act as reinforcement home visits enhancing ideas

and concepts with information regurgitation.

In order to conduct such activities, a variety of resources will need to be utilized to

efficiently execute the desired outcomes. Being limited to a strict budget, proper and necessary

allocation and documentation of resources must be a priority when implementing the following

activities. Different neighborhoods and sub-communities will need a health educator who knows

the language and culture. Ten health educators will be sent to various communities within the

target geographic locations in Long Beach and within each visit, an asthma educator will conduct

a comprehensive, concise, and personal asthma education presentation, proper inhaler and

medication use demonstration, and a house inspection looking for asthma triggering agents.

Recruitment will be achieved through a variety of mediums in partnership with St. Marys

hospital, the central hospital in the desired geographic location. Since doctors do not have the

time to conduct in-depth education with their patients on asthma, this program can be referred to

patients by doctors to lessen that burden, incentivizing program promotion. Doctors or

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respiratory therapists can refer a patient by giving a referral, brochures, flyer, business cards, or

website links of the program. The second recruitment method will consist of interns being sent

into the community to post and pass out flyers in different locations our desired population will

likely be. Some examples may include places near clinics, shopping centers, parks, restaurants,

and community centers. The third recruitment method will involve giving brochures to local

community-based organizations to give to their clients. Other methods of recruitment will

include hospital and clinic waiting room brochures, referrals through a partnership with the

American Lung Association, and booth advertisement at American Lung Association Lung Force

Walks.

Certified Health Educators will be used to conduct the home visitations. When hiring,

previous asthma education training and certification is preferred, but asthma education training

and certification will be provided for all educators prior to program implementation whether or

not they have had it. The training will be conducted through the American Lung Associations

Asthma Educator Institute whose standards and accreditation are an exemplary resource for

meeting the standards of the program. The program is a 2-day course which prepares each

educator with the education and credentials to properly implement the program. After all asthma

educators are certified, based on the testimonies of the key informants, each educator will be sent

to the specified house of the participant who signed up. Educators will be sent based on race and

language to create a comfortable environment for the participant. Each participant will need to

schedule a time for a home visit that best fits their schedule. Typically, this will be during

evenings after the typical adult work day and on the weekends. Once the educator has been

invited into the home of the participant during the scheduled appointment, they will begin with

an introduction of themselves and the program, giving their credentials. This ensures the
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participant that the information provided can be trusted and that the information has importance.

After the introduction, the consent form and a pretest will be administered before the first

activity begins during the first home visit. Each asthma educator will bring with them two

dummy sample inhalers with two standard spacers and two whistle spacers, a visual diagram

board to enforce material, and an information packet for the participant to keep.

Program Activities

Activity 1

Health educators will begin with a formal asthma education activity, given in an

interpersonal, one-on-one lecture fashion, welcoming any dialogue and questions during the

educational segment. The health educator will need to ask the participant to find a comfortable

space to sit where they can be un-interrupted for about two hours. This activity will cover the

basics of asthma including: the definition, burden of asthma in Long Beach, simple

pathophysiology, all risk factors associated with asthma, purpose and uses of different asthma

medicines, asthma prevention applied to participants lives, the importance of proper inhaler use,

how to properly manage asthma in everyday life, the dangers of improper asthma management,

and different triggers to look for in their house. All information needs to be portrayed in simple

and understandable language for best retention by the participant. The visual diagram board,

which will be 3X 3, will have print large enough for the average adult to read. This board will

contain anatomical diagrams, facts, simple charts, and act as a general guideline for the educators

to reference while educating the participant. It is important that the educator uses the board

during the asthma education activity to better grab the attention of the participants while

enforcing important concepts. Keeping the board facing towards the participants and pointing out

key information is necessary because there are different learning styles among different people
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and educators need to be adaptive to these learning styles. All medical jargon will be used

sparingly and is ultimately up to the discretion of the educators as some participants will need

simple language while some can understand complex medical jargon. This ensures that the

information is being retained and understood and will be enforced through dialogue and

questions asked by the participant. By the end of the asthma education activity, the goal is to

increase the participants knowledge of asthma definition and basics, risk factors, prevention, and

how they can apply this knowledge to their own lives, which is directly linked to impact outcome

number one.

Activity 2

Directly following the education activity, the educators will transition into the proper

inhaler usage demonstration activity. This is an important activity because improper inhaler

usage can be a very common issue among those with asthma. The educator will refer back to the

different kinds of medicines used to treat asthma and demonstrate improper versus proper inhaler

use. The resources needed are two dummy inhalers, two standard spacers, two whistle spacers,

and one information packet. Using the dummy sample inhaler without a spacer, the educator will

perform the improper method of inhaler use, and explain why this form is ineffective and will

show a diagram enhancing the concept. The pre-test for the demonstration will consist of a quick

scenario asking the participant to act as if they were using their inhaler and marking on a

checklist the important steps needed to effectively use an inhaler. The health educator will then,

attach the standard spacer to the inhaler, explain why and how it is used, and demonstrate the

proper way to use an inhaler. It is important to explain that taking deep, slow breaths and holding

it for ten seconds is necessary and why it is necessary. Next, the educator will attach the whistle

spacer to the inhaler, explain how and why it is used and demonstrate the same technique for
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proper inhaler use with the whistle spacer. This is important because it gives the participants

options, knowledge to overcome barriers and the freedom to choose inhalers that best work for

them as well as demonstrate how to use those options. After the educator demonstrates the proper

technique for inhaler use, they will assist the participant with practicing their technique three

times using the second dummy inhalers and spacers. Once the educator has determined proper

technique has been achieved, they will review all information one last time, give the participants

an information packet which highlights all key information reviewed in the session and proper

inhaler use, and then address any questions from the participants. By the end of the activity, the

participant will be able to demonstrate proper usage of an inhaler, know how to use and attach a

spacer, know options of spacers available to them, and have received an information packet, all

of which is linked to impact objective two.

Activity 3

The final activity that educators will perform with the participants is a home inspection.

The home inspections objective is to identify any possible asthma triggers within the

participants household, to inform them of other common triggers, and advise them on how to

reduce the risk of an asthma attack from occurring. The educators and participants will go

through each room in the household to analyze the condition of the rooms by examining the

furniture, pipes, as well as find cracks and molds in the home. Following the inspection, the

educators will write a list of the potential asthma triggers within the participants home that needs

to be addressed and explain how to address them. Then, the educators will instruct the

participants on the importance of: cleaning the home and furniture to prevent dust, dust mites, as

well as mold from accumulating; the need to repair any damaged or leaking pipes to avoid

growths of mold; washing dishes, kitchen appliances, and taking out garbage regularly; bathing
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pets regularly; and limiting exposure to tobacco (ACAAI, n.d.). An educational pamphlet of

known household asthma triggers and how to reduce these triggers will be provided at the end of

the inspection. An indoor asthma trigger checklist will be administered at the first home visit and

reinforcement follow-ups to assess whether or not the participants have reduce indoor asthma

triggers. This activity achieves the third impact objective by educating the participants to reduce

asthma triggers within the household.

Volunteer Recruitment

Volunteers will be needed for this program to serve as promotoras. The role of the

promotoras will be to promote and advocate for the program. In order to do that, they too will go

through a short training and learn about the purpose of the program so that when they go out to

sponsor it, they will have accurate information and responses to possible questions. Priority

volunteer opportunities will be given to university students who are health science/public health

majors. Recruitment will occur by visiting local campuses and informing Health Science

students about a new internship opportunity. They will further be primed on the tasks and

qualifications of the opportunity, making clear that they will have to undergo a training, as well

as a pre-test and post-test before and after to monitor the knowledge accumulated during the

training. Volunteers who participate throughout the entire time of advocacy and promotion of the

program will receive a letter of recommendation that could be utilized for future opportunities. In

addition to that, volunteers will get internship hours applicable towards their degree as well as

significant experience that can added to their rsum. Lastly, as a supplemental token of

appreciation, volunteers will receive a care package that will include a t-shirt and coffee cup with

the program name and logo.

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References

HOME Allergy Management | ACAAI Public Website. (n.d.). American College of Allergy,

Asthma & Immunology. Retrieved October 20, 2016, from

http://acaai.org/resources/tools/home-allergy-management