TY - JOUR
T1 - Efficacy of a lay community health worker (promotoras de salud) program to improve adherence to emollients in Spanish-speaking Latin American pediatric patients in the United States with atopic dermatitis
T2 - A randomized, controlled, evaluator-blinded study
AU - Chen, Henry W.
AU - Limmer, Emily E.
AU - Joseph, Adrienne K.
AU - Kinser, Kathryn
AU - Trevino, Amanda
AU - Valencia, Angel
AU - Weinheimer, Rachel A.
AU - Youssef, Sara Hassan
AU - Cervantes, Cecilia
AU - Guzman, Maria Teresa
AU - Morales, Ana
AU - Morales, Sandy
AU - Contreras, Maurica
AU - Eifert, Faye
AU - LaMontagne, Darci
AU - Nouri, Sarah
AU - Reyes, Fabiola
AU - Pandya, Amit G.
AU - Dominguez, Arturo R.
N1 - Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. Objective: To create and evaluate a promotora-led education program for Spanish-speaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. Methods: Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. Results: Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%–61%]) versus non-promotora (median [IQR]: 20% [11%–49%]) (p =.09) groups. SCORAD, AD knowledge, and Spanish-language Parental Quality of Life Questionnaire for AD (Sp-PIQoL-AD) improved in both groups, although there was no statistically significant difference between groups. There was a trend toward increased AD knowledge at Week 4 (p =.06) in the promotora group. Conclusions: A promotora-led educational intervention is a promising approach in increasing caregiver medication adherence in pediatric, Latin American patients with AD in the United States. Further research using creative and culturally appropriate strategies to increase medication adherence is necessary to reduce health disparities in other racial and ethnic minority populations in the United States.
AB - Background: Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. Objective: To create and evaluate a promotora-led education program for Spanish-speaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. Methods: Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. Results: Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%–61%]) versus non-promotora (median [IQR]: 20% [11%–49%]) (p =.09) groups. SCORAD, AD knowledge, and Spanish-language Parental Quality of Life Questionnaire for AD (Sp-PIQoL-AD) improved in both groups, although there was no statistically significant difference between groups. There was a trend toward increased AD knowledge at Week 4 (p =.06) in the promotora group. Conclusions: A promotora-led educational intervention is a promising approach in increasing caregiver medication adherence in pediatric, Latin American patients with AD in the United States. Further research using creative and culturally appropriate strategies to increase medication adherence is necessary to reduce health disparities in other racial and ethnic minority populations in the United States.
KW - Latin American
KW - MEMSCap
KW - adherence
KW - atopic dermatitis
KW - community health workers
KW - health education
KW - pediatric
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UR - http://www.scopus.com/inward/citedby.url?scp=85140225796&partnerID=8YFLogxK
U2 - 10.1111/pde.15148
DO - 10.1111/pde.15148
M3 - Article
C2 - 36263875
AN - SCOPUS:85140225796
SN - 0736-8046
VL - 40
SP - 69
EP - 77
JO - Pediatric dermatology
JF - Pediatric dermatology
IS - 1
ER -