Clark 2013.
Methods |
Study design: controlled before‐after (independent samples) Sampling frame: lower‐income areas in the US cities of Washington, DC; Hampton Roads, VA; San Juan, PR; Milwaukee, WI; Seattle, WA; Long Beach, CA; and Philadelphia, PA, with high asthma prevalence Sampling method: convenience Collection method: in‐person interviews with parents or guardians of children Description of the community coalition: The Robert Wood Johnson Foundation funded coalitions in 7 regions of the USA with the goal of changing policies and practices regarding asthma management in low‐income communities of color. The University of Michigan Center for Managing Chronic Disease served as the national program office. At each site, a coalition was formed comprising stakeholders including local healthcare providers, schools and day care centers, community advocacy groups, businesses, local government organizations, academic institutions, parent groups, and other community‐based organizations. Community contexts and coalition processes and structures differed at each site, but a common core of process and outcome evaluations were applied |
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Participants |
Communities: Washington, DC; Hampton Roads, VA; San Juan, PR; Milwaukee, WI; Seattle, WA; Long Beach, CA; Philadelphia, PA Country: USA Ages included in assessment: 0 to 17 years Reasons provided for selection of intervention community: communities of color with high asthma prevalence Intervention community (population size): approximately 75,000 across sites Comparison community (population size): similar but actual number not given |
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Interventions |
Name of intervention: Allies Against Asthma Theory: not reported Aim: to create population‐wide, macro‐level changes in asthma management practices and policies Description of costs and resources: Each site received up to $1.3 million per year Components of the intervention: education in homes, at community sites and for providers; changes in schools, child care centers, and recreation facilities to improve asthma management; care co‐ordination and case management; clinical quality improvement including standardized referrals, protocols, and action plans; establishment of registries; improved reimbursement and financial incentives; and policy change initiatives enacted. Each site employed a combination of most of these components Start date: 2000 Duration: 5 years |
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Outcomes |
Outcomes and measures: comparative data on parent reported asthma symptoms; parental quality of life. Descriptive data on coalition characteristics and policy and systems change Time points: baseline and 12 months |
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Notes | Funding source: government | |
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | High risk | Controlled before‐after study with convenience sampling |
Allocation concealment (selection bias) | High risk | Allocation not concealed |
Baseline outcome measurement similar | Low risk | Baseline measurements reported were similar |
Baseline characteristics similar | Unclear risk | Adjusted for baseline differences in race and age groups |
Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Blinding not reported |
Incomplete outcome data (attrition bias) All outcomes | High risk | Attrition 36% |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Blinding of participants not reported |
Protection against contamination | Unclear risk | Description of control recruitment not detailed; however, state they were recruited in areas where coalition activity was limited or absent |
Selective reporting (reporting bias) | Unclear risk | All outcomes collected were not specified in paper |