Community engagement can help stock inhaler programs succeed in rural schools
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Key takeaways:
- The researchers used feedback from interviews and a focus group to develop an engagement strategy.
- Liability concerns and a lack of school nurses are among the barriers to implementation.
BOSTON — Community engagement can help stock inhaler programs for underserved rural schools succeed, according to two posters presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“Asthma is very common. But a lot of kids don’t have their own personal inhalers due to under-diagnosis and lack of access to medical care,” Emily Wilt, BS, a third-year student at the University of Illinois College of Medicine, told Healio.
In 2018, Illinois passed legislation that allows schools to keep stock rescue inhalers on site for anyone who may need them to treat an asthma attack.
“But implementation has been slow, especially in these rural areas, which have a unique need due to increased distance to emergency medical services and lack of health care workers in the school,” Wilt said.
Wilt and her colleagues noted that EMS has a 14-minute median time to arrival in rural areas and that the wait is 30 minutes in 10% of encounters.
“Our objective was to try and determine how we could tailor our engagement strategy to better speak to these rural schools and their unique facilitators and barriers to stock inhaler implementation,” Wilt said.
Developing the strategy
The researchers interviewed 21 partners in rural school health. School engagement, the need for stock inhalers and barriers to stock inhaler implementation emerged as themes in these discussions.
For example, Wilt said, engagement requires providers to build trust with the community. Also, providers should identify a local figure who can support the cause.
A lack of health care workers in the school, in addition to a lack of access to primary care physicians and to specialists, along with prescription issues, all drive the need for stock inhalers in schools, Wilt continued.
Additionally, she said, providers need to recognize that schools often have competing health priorities and that they are overwhelmed by other needs that they need to serve as well.
“Mental health is a big priority for a lot of these schools right now,” she added.
“The biggest thing is the financing,” Wilt continued. “Schools don’t have the money or the resources to be dedicated to these programs.”
Using a seven-person focus group, the researchers took the insights gained from these discussions to craft an engagement strategy for approaching rural schools to implement stock inhaler programs along with other school-based health policies.
“We came up with four themes,” Paige Hardy, MPH, research coordinator with the University of Illinois College of Medicine, told Healio.
The top theme was successful engagement strategies.
“They really talked about working with community health champions, people that go above and beyond to better their community and implement these programs,” Hardy said.
The focus group also said that groups should conduct needs assessments in these communities before proposing any interventions.
Second, Hardy said, communication with schools should be concise.
“They really suggested that we employ precise top-down messaging tailored to rural concerns and use both personal storytelling and facts and figures,” Hardy said.
Next, the focus group addressed the unique characteristics of rural schools, which may include geographic isolation, a strong sense of community, insularity and generosity.
“They also discussed implementation barriers to stock inhalers,” Hardy said.
These include communication challenges, liability concerns, a lack of school nurses and difficulties in finding physicians who will support these programs.
“What was interesting about what was discussed in the focus group? None of it was things that are unique to rural areas. This is something that schools that aren’t eligible for the state funding all face,” Hardy said.
“Even some schools that are eligible for state funding, they might have the prescription, but they all deal with communication challenges and liability concerns and potentially not having a school nurse,” she continued.
Seven steps
These conversations led to a seven-step strategy for engaging rural schools and implementing stock inhaler programs or any other health policy.
“Step one would be to identify our key local school health champions,” Hardy said.
These people may include influential figures and leaders such as members of the school board, superintendents, health department leadership, primary care providers, school administrators and nurses, and other community leaders. Existing connections and collaborations may be used to identify these potential champions.
“Step two would be to engage with them in person preferentially,” Hardy said.
This step requires establishing communication and building trust through continued contact and enhanced collaboration with the champion. Discussions about the specific school health issue and its community context should be scheduled. During these discussions, how the health policy will fit into community should be addressed.
The third step, the community-led needs assessment, should follow.
“We shouldn’t assume schools are in need just because they’re rural. We need to figure out, community by community, what do they want? What are the major health barriers? How can we help, and how can we fill that need?” Hardy said.
This assessment can be conducted in many forms, such as key informant interviews and online surveys. Analysis should evaluate EMS response times, distance to the hospital or ED, whether school nurses are on site, and the prevalence of other issues.
“Part four would be to approach the community in the school district with our local health champions so they will be the best suited to navigate that particular school,” Hardy said. “Every school is very, very different.”
School health champions should meet with school administrators and nurses in person, build rapport and trust with them, address any perceptions of a lack of need or interest, and provide education about liability, training and costs.
“Part five would be to highlight the benefits and barriers within the school,” Hardy said.
This would include using community assets to address the barriers identified by the needs assessment, collaborating on strategies for mitigating these barriers, using specific health initiatives to show how policies make schools safer, including personal stories about the benefits of these policies and tailoring presentations to address local challenges.
Step six is a guided implementation of the policy.
“We don’t want to just hand the schools a bunch of materials and leave them to do whatever they will,” Hardy said. “We want to support them through the process.”
This should include a standardized step-by-step framework complete with resources for implementing the policy and collaboration to finalize areas with specific needs. Staff also should receive comprehensive and flexible training. Educational documents about the benefits of the policy and its importance to families should be provided as well.
“We want to be taking on as much work as we can,” Hardy said. “These schools are overloaded, so very, very busy. So, it’s important that the more work we can do, the less work that they need to do.”
The final step is ongoing support and evaluation.
“We want this to be sustainable after we leave, and we want to make sure we actually are measuring their outcomes,” Hardy said.
The researchers recommended establishing a consistent check-in schedule to monitor implementation and address emerging challenges or opportunities, in addition to an evaluation framework for assessing the impact of these policies on the community.
These implementation strategies should be adapted based on any findings produced by evaluations, emerging trends in health, or changes in what the community needs, the researchers continued.
Further, the researchers said continued funding and standing prescriptions should be secured to ensure sustained access to resources. Finally, they said, community needs assessments should be repeated as needed.
Into the real world
“The next step for this study will be to implement a pilot program of stock inhalers in a school that either isn’t covered by the statewide funding or who isn’t participating in statewide funding,” Hardy said.
The state of Illinois is funding stock inhaler programs, and the Allergy and Asthma Foundation of America is managing their administration.
“That’s really great, because they covered 84% of the schools across Illinois,” Hardy said. “Unfortunately, that’s not 100%, so they had to choose which schools to prioritize.”
Schools were chosen based on enrollment and asthma prevalence per county.
“Some rural schools were left out of that,” Hardy said.
Hardy emphasized these programs would train additional school personnel in when and how to administer stock inhalers.
“You don’t necessarily need to be a school nurse. You do need to complete training. Anybody can be trained,” she said.
Still, Hilt said, potential obstacles remain.
“What we found in some of our interviews is that even with the training, people who aren’t coming from a health care background are hesitant to administer the medication,” she said. “So, that’s another barrier that we’ll be looking to address.”
Reference:
- Ongtengco A, et al. Rural school engagement and stock inhalers: Utilizing focus groups to guide implementation strategies. Presented at: ACAAI Annual Scientific Meeting; Oct. 24-28, 2024; Boston.
For more information:
Emily Wilt, BS, can be reached at eawilt2@uic.edu. Paige Hardy, MPH, can be reached at paigelh2@uic.edu.