PROJECT SUMMARY/ABSTRACT Children in families with healthcare communication in a language other than English (LOE) are at increased risk of worse asthma care and outcomes compared to those without a language barrier. There is a gap in knowledge about effectiveness and implementation outcomes of interventions to address asthma disparities for children in LOE families. Asthma navigators play a key role in asthma education and care coordination, resulting in improved asthma outcomes. Our local model of asthma navigation and care coordination to support meeting social determinants of health needs using a lay health worker model has improved asthma outcomes among urban racial/ethnic minority children but has not focused on children in LOE families. To address this gap, we propose, the Navigating Toward Equitable Asthma Management Program (Nav-TEAM) intervention, an adaptation of evidence-based asthma navigation specifically for children in families who communicate in LOE. As with existing asthma navigation programs at our health system, Nav-TEAM will align with EXHALE, the Centers for Disease Control and Prevention National Asthma Control Program compilation of asthma management strategies that have been proven to reduce asthma-related healthcare utilization and costs. The overall scientific goals of this community-engaged study are to: evaluate the effectiveness of Nav-TEAM on pediatric asthma outcomes for 280 children whose families communicate in LOE, evaluate implementation outcomes and application of implementation strategies, and assess cost and contextual factors to support sustained implementation, scale up and scale out. The study will be implemented in a large primary care clinic serving primarily Medicaid-insured children and in subspecialty pediatric pulmonary clinics using the Practical, Robust Implementation and Sustainability Model (PRISM) - inclusive of RE-AIM (Reach, Effectiveness, Adoption, Implementation Maintenance outcomes with an equity lens – as the guiding Dissemination & Implementation Science framework. We will use community-engaged processes to tailor asthma navigation for LOE families in primary and subspecialty pediatric pulmonary care settings at Children’s Hospital of Colorado, a large academic children’s health system serving urban and rural patients. Subsequently, we will conduct a hybrid type 2 effectiveness-implementation trial to simultaneously evaluate the effectiveness of Nav-TEAM at reducing asthma-related emergency department use among children with asthma age 4-14 years using a pragmatic randomized controlled trial as well as a mixed methods assessment of implementation using PRISM/RE-AIM focusing on equity. We will then assess cost, sustainability and contextual domains to understand factors that enable implementation, sustainability, and scale-out of Nav-TEAM. Results from this study will provide information on the effectiveness and implementation of evidence-based asthma navigation adapted specifically for families who communicate in LOE, and will offer lessons that we will capture in an implementation and sustainability guide to promote scaling to other clinical settings.

PROJECT NARRATIVE Children in families with healthcare communication in a language other than English (LOE) are at increased risk of worse asthma care and outcomes compared to those without a language barrier. The proposed research addresses the gap in knowledge about effective interventions to address asthma disparities for children in LOE families through a hybrid type 2 effectiveness-implementation trial of the Navigating Toward Equitable Asthma Management Program (Nav-TEAM) intervention which is an adaptation of evidence-based asthma navigation specifically for children in families who communicate in LOE. Our mixed methods implementation evaluation using PRISM (Practical, Robust Implementation and Sustainability Model), the contextual expansion of the RE-AIM framework with an equity lens and assessment of cost, sustainability and contextual domains will promote sustainability and scale-out of Nav-TEAM.