Comprehensive Self-Management Support for WTC Responders with Asthma
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Asthma is one of the most common physical health conditions in World Trade Center (WTC) responders, affecting approximately one third of individuals. Moreover, most WTC responders with asthma continue to report substantial symptoms, experience poor disease control, and have high acute resource utilization and healthcare-related costs. Thus, asthma remains a major cause of morbidity and compromised quality of life in this population. Management of asthma in WTC-exposed individuals can be challenging. High prevalence of physical comorbidities (e.g., chronic rhinitis, obstructive sleep apnea) and mental health problems (e.g., post- traumatic stress disorder, depression) that contribute to increased asthma morbidity are common among WTC responders. Active self-management is critical for achieving adequate long-term asthma control. Unfortunately, low adherence to self-management behaviors (SMB) is a common problem and may involve unique pathways (e.g., WTC-specific disease and medication beliefs) in WTC responders. Cognitive decline due to aging and WTC exposures can further complicate asthma self-management. The complex constellation of medical, cognitive, and mental health conditions accompanying asthma in WTC responders necessitates comprehensive self-management support (SMS) interventions to improve their outcomes and quality of life. Unfortunately, there are no available interventions to improve the outcomes of this population. We previously developed and successfully tested the Supporting Self-Management Behaviors for Adults (SaMBA) program. The SaMBA model of SMS is an evidence-based approach grounded in a theory of health behavior that is unique among chronic illness SMS programs because its strategy involves comprehensively screening for barriers to effective self-management and disease control and couples it with tailored, theory-based, barrier- specific interventions. In this study, we propose to adapt the SaMBA model to the needs of WTC responders with asthma. Our Specific Aims are to: 1) Enhance and adapt an asthma SMS model for WTC responders with asthma (SaMBA-WTC), with input from WTC responders and other stakeholders to validate content and protocols and 2) Conduct a pilot RCT of SaMBA-WTC to determine feasibility and preliminary impact, in preparation for a fully powered trial. We will conduct a pilot RCT (n=58) of the SaMBA-WTC model delivered to WTC responders for 3 months vs. a time-matched asthma education attention control. Data will be collected at the end of the 3-month intervention (3-month visit) at 3 months later (6-month visit to assess sustainability). Clinical outcome measures will include asthma control, quality of life, resource use and measures of asthma self-management. The intervention is significant for its attention to the full range of factors that contribute to suboptimal self-management and poor outcomes among WTC responders with uncontrolled asthma. It is innovative for its comprehensive and theory-based screening approach to identifying and addressing coping strategies and barriers to effective SMB in asthma in this specific population.
