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Running head: ASTHMA CONTROL AND EDUCATION IN LONG BEACH
Asthma Control and Education in Long Beach
Jorge Guerrero
Jason Levalle
Valeria Macias
Imani Moses
Harry Ta
California State University, Long Beach
Dr. DAnna
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Group Leads
Problem of Justification and Needs Assessment: Jason Levalle
Program Goals and Objectives: Imani Moses
Key Informant Interview: Valeria Macias
Implementation Program: Harry Ta
Scope of Work:Jorge Guerrero
Budget and Budget Justification: Jason Levalle
Evaluation Plan: Imani Moses
Marketing/Recruitment/Promotion: Jorge Guerrero

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Problem Justification and Needs Assessment
Asthma is a chronic respiratory disease that affects 17.7 million adults in the United
States (Center for Disease Control and Prevention, 2016). Mucus builds up and obstructs the
airways making it hard to breathe causing chest tightness and wheezing. Several factors can lead
to a person developing asthma. If a parent has asthma, their child has a higher risk of developing
the disease compared to a child whose parents do not have asthma, even if they live in the same
environment (National Institute of Environmental Health Sciences, 2016). Poor air quality also
can lead to a person developing the disease as well as allergens inside of a home. These allergens
include dust mites, animals, mold, and fungi (National Institute of Environmental Health
Sciences, 2016). Any one or combination of these factors can trigger an asthma attack. Although
the exact cause of this disease is unknown, it is manageable. It can be controlled to the point
where everyday activities can be done without complications. Despite this, a significant number
of people visit the emergency room for asthma. In 2011, there 1.8 million emergency room visits
with asthma as the primary diagnosis (CDC, 2016). More than 1 in 5 adults are considered to
have very poorly controlled asthma (CDPH, 2013). This disease costs the United States $56
billion per year (Environmental Protection Agency,2016). In 2012 it cost the US $52 billion
(EPA, 2016). These numbers demonstrate the negative effect this disease is having on the United
States.
Although it is a widespread disease that does not pick and choose who it affects,
Hispanics and African Americans have been disproportionately affected. These two ethnic
groups make up 45.3 percent of the United States population (U.S. Census Bureau, 2015). There
have been plenty of programs created for children in this racial class, but not as many for adults.
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Currently five million people in California have asthma with 189,700 new cases each
year (California Department of Public Health, 2013). A total of 649,000 adults reported missing
work due to asthma, which totaled to 11.8 million work days (CDPH, 2013). Prevalence of this
disease among African Americans is 30-40 percent higher compared to White adults (CDPH,
2013). Hispanics also have a higher rate of Asthma compared to white adults (CDPH, 2013).
Three million Hispanics have asthma in the U.S. (CDC, 2016). African Americans are
three times more likely to die from Asthma and more African American women have died from it
compared to other groups (CDC, 2016). It is clear that there are disparities as far as treatment
and control of the disease in these two ethnic groups. The goal of this program is to work with a
community with a significant Hispanic and African American population, educate and empower
them to manage their asthma, and decrease emergency room visits as their primary treatment.
According to the Director of Community Engagement of the American Lung Association, Long
Beach California is an area with a high Hispanic and African American population that relies on
the emergency room as their primary treatment center for asthma.
Target Population
Hispanic and African American males and females ages 25-55 are subgroups that are at
higher risk for asthma (CDC, 2016). Director of Community Engagement for the American Lung
Association Anthony Ortiz-Luis highlighted the fact that the 710 freeway, mainly near the Port of
Long Beach, is a particularly threatened area in terms of poor air quality. The reason this occurs
is because poor air quality tends to congest the surrounding areas due to the diesel emission of
the railroad locomotives, harbor craft, ships, trucks, and cargo-handling equipment. The harmful
components in this low quality air include diesel particulate matter, nitrogen oxides, and sulfur
oxides. It is very common for African Americans and the Hispanic/Latino population to live in
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this area and to be of low socioeconomic status. Because of their low socioeconomic status, we
see trending health issues such as high prevalence of asthma (CDC, 2016). There is a significant
health disparity amongst this population and this is typical because this population resides in
unsafe neighborhoods that are detrimental to their health. It is estimated that 33% of the
residents that live in this area were born from a foreign country and they typically live in the
southern part of Long Beach [North of Signal Hill along the 710 freeway] which has the highest
poverty level, the lowest homeowner rate and has a high percentage of nearby commercial
uses(Li et al., 2014, para.19).
Many people tend to associate asthma with children when in reality it is just as an
immense problem among adults; now more than ever. Recent research has showed that asthma is
on the rise, especially in the last decade. According to the Centers for Disease Control and
Prevention (CDC), the proportion of people with asthma in the U.S. has increased to 15%
(2016). Looking more specifically at California, there are two races that are affected by this
respiratory disease more than other races. The most affected would be African American adults
with Hispanics following not too far behind. The prevalence rate for self-reported lifetime
asthma for Hispanic adults in California is 9.8%. In the case of Black Non-Hispanic adults in
California, that number is 20.8%, compared to 12.6% in Caucasians (CDC, 2016).
The impact of asthma in relation to the target population is also quite significant,
particularly because many people within the target population that are suffering from asthma are
not seeking proper medical attention, and for the most part it is because several factors including
cost and lack of knowledge about available resources (Speck et at., 2014) . The CDC also stated
that African American adults are hospitalized for asthma complications more often than white
adults (2016). In addition to that, many African Americans and Hispanics do not obtain asthma
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care for the reason that 1 in 4 and 1 in 7 of them, respectively, cannot even afford routine doctor
visits (CDC, 2016). Moreover, part of asthma care and management can sometimes include the
use of prescribed medication. The cost of the medication can also create a barrier for the target
population. The CDC also reported that 1 in 4 African American adults and 1 in 5 Hispanic
adults are not able to afford asthma medication (2016). Overall, the impact of asthma on the
target population is substantial in view of the fact that that it is dealing with an ethnically
minority population.
Social Consequences of Asthma
Asthma has a significant negative social impact on those struggling with the disease.
One social consequence results from asthma creating anxiety in adults, hindering social life.
According to one study, as much as 24% of those with asthma also have anxiety disorder
(Lieshout & McQueen, 2008). For example, someone with an asthma related anxiety disorder
may feel less willing to participate in healthy exercise outdoors with friends because they feel it
is too risky. Another social consequence includes asthma in working adults. Asthma is
responsible for 11.8 million missed workdays in the United States in 2002 (Gelfand, 2008).
Asthma can significantly increase the amount of missed work days among the African American
and Latino population in Long Beach if the issue is not addresses accordingly. African
Americans and Latinos have an asthma hospitalization rate of 39.2% and 10.4%, respectively
(Long Beach City Health Department, 2013). Working less leads to less money being made,
which in turn can cause stress. According to Dr. Pramod Kelkar, stress is another common
asthma trigger that affects your day to day life (HealthAlliance.org, 2016). Dr. Kelkar argues that
it is a cycle, asthma causes stress and stress causes asthma. Missed work days and stress could
also hinder the working relationships with colleagues in the workplace, causing a loss of
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productivity. Overall, the mentioned social consequences that result from asthma can be
magnified in the Hispanic and African American populations due to the fact that minority
populations are already socially displaced, creating strong disparity in populations where asthma
and race and ethnicity cross.
Current Solutions to the Problem
A variety of programs have been implemented in Long Beach addressing asthma within
numerous populations; all of which have strengths and weaknesses within them. The Long Beach
Alliance for Children with Asthma is an organization which implements many different asthma
related programs focusing on children in Long Beach. Their school asthma program aims to
reduce the incidence of asthma attacks in Long Beach schools and uses a variety of methods to
achieve that goal.
There are a variety of strengths that can be drawn from this program. For example, the
different methods used within this program are all contained within the schools themselves, thus
adhering to the idea of keeping the program contained in a specific community. While the goal is
to reduce asthma attacks among children in schools, the target population is not just the children
themselves. The program is split up into two target areas: Education and Environmental
Management. Interestingly enough, since children depend so much on school, faculty and staff,
the program aims to educate nurses, teachers, parents, and the school administrators. The
program runs School Nurse Luncheons which provide current information regarding asthma such
as recognition, management, and medication delivery training. For students, parents and other
school staff, the Open Airways Program for Schools aims to educate and raise awareness of the
dangers and solutions to handling and preventing asthma attacks. Also within the program, an
environmental element consists of preventing and providing remedies for indoor air quality
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problems. Air Quality Flags is a program which locates red or orange flags regarding indoor
air quality of schools in Long Beach. This provides students and staff the knowledge of their
schools indoor air quality. If a child who is sensitive to poor air quality or predisposed to asthma
attacks is warned ahead of time they can better prepare themselves to make a decision about
attending a certain school or bringing their inhaler.
The program being created targets adults aged 25-55 and not school aged children like
the Long Beach Alliance for Children with Asthma. Though, some ideas can still be applied to an
adult population. Primary solution ideas like asthma education in the workplace, environmental
and indoor air quality control in Long Beach, and easier access to medication are all possibilities
to consider when formulating such a program.
While this program, for the most part, uses out of the box techniques at reducing the
number of asthma attacks in Long Beach schools, it flaws in different aspects as well.
Implementing a program with a variety of sub-programs seems, on paper, to better help strive
towards the main goal. Although, when a program starts implementing too many sub-programs,
the different working parts need to work as a system. Like many systems, if one component fails,
it affects the others, thus not reaching the goal of the system. So while evaluating the School
Asthma Program from the Long Beach Alliance for Children with Asthma, certain concepts and
ideas will be considered when creating a program.
Another solution to the asthma problem in Long Beach is educating individuals through
workshops by the Asthma Life Skills Academy for Adults (ALSAA). These workshops and
seminars offered basic information about asthma and allergies, as well as provided participants
with techniques for asthma care and how to prevent asthma attacks in the home. The participants
were also taught about the difference between air quality indoors and outdoors, and were shown
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a few demonstrations of non-toxic cleaning methods. As a result of the program, 84% of
participants believed that the knowledge and experience that were taught at these workshops
were constructive and will improve the safety of their homes and neighborhoods (ALSAA,
2013).
This method is appropriate to address the needs of the Hispanic and African American
population in Long Beach; however, the community workshops can be further improved.
According to the data by ALSAA (2013), the program had succeeded in educating its participants
about general information of asthma and helping the community members realize the importance
of indoors and outdoors air quality. Although the workshops have been successful in the
education aspect, the program has failed to captured the communitys attention and retain its
members. 182 people enrolled in the program, but only 145 remained throughout the entire
program (ALSAA, 2013).
A suggestion to gain more participants in the program is to conduct more workshops at
different times throughout the day. Community members may not be able to attend the
workshops due to work and other personal reasons. If more seminars are held throughout the day,
then that allows more opportunity for the community members to attend. Another suggestion is
to provide transportation to and from the workshops as an incentive for community members.
Conclusion of Justification
Asthma has lasting effects on the economy, productivity, and is costing taxpayers more
and more money each year (Bahadori et al., 2009). According to a 2009 systematic review on the
economic burden of asthma, the combination of direct costs, such as medication costs and
hospital visits, as well as indirect costs, such as loss of productivity due to missed workdays and
disability, have a significant negative impact on the economy (Bahadori et al., 2009). Not only
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does this affect taxpayers, but adult Hispanic and African American community members of
Long Beach are left with the burden of asthma management and medicinal treatment with little
education and support from the community. Asthma is a chronic condition with severe attacks
that need immediate treatment and care. Asthma accounts for about two million emergency
rooms visits each year in the United States (CDC, 2011). With the empowerment of the Long
Beach community, a strong program focusing on asthma prevention and management can have
lasting economic and social benefits.
Program Goals and Objectives
Program Goal:
Reduce the number of asthma attacks among African Americans and Hispanic adults aged 25-55
in Long Beach.
Process Objectives:
During month 1, a meeting will be held with local community based organizations to get their
perspective on asthma in the target population.

During month 1, local Community Based Organizations will distribute 300 flyers and brochures
in the target neighborhood to assist in gaining entry into the community.

During month 2, home visits will be scheduled with referred participants through a phone, email,
or website sign up.
Impact Objectives:
Participants will increase their knowledge of signs and symptoms of asthma attacks by 10% as
measured by a pretest at first home visit and posttest at last home visit from months 3-17.
Participants will demonstrate how to properly use an inhaler after receiving detailed instructions
by a community health worker during months 3-17.

Participants will reduce asthma triggers in their household by 15% within months 11-17 from
first inspection to the final inspection as measured by a checklist.

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Outcome Objectives:
Asthma-related emergency room visits will be reduced by 50% among program participants by
month 18 of the program.

In June 2019 at one- year follow up, 75% of participants will carry their inhaler.
Implementation Plan
Program Model Theory
The program planning model that will be used in our program is the MAP-IT model. This
model consists of five components that clearly outline the steps that need to be taken in order to
develop a program that will self-empower the target population and ensure the positive change
will be sustained after the program ends. The first component involves mobilizing individuals
and organizations. Meeting with local Community-Based Organizations will occur in order to
reach our target population. Forming this coalition with current existing organizations will build
a trust within the community that will then be used to help them with the burden of asthma. A
partnership will also be made with St. Mary Medical Center, the primary hospital in the target
geographic area. Patients who get seen for asthma related complications will be referred to our
program Asthma Control and Education in Long Beach, ACE-LB for short. The second
component is to assess the areas of greatest need in our community. Asthma rates tend to be
higher in lower socioeconomic neighborhoods with poor air quality (Environmental Protection
Agency, 2016). African Americans and Hispanics have higher rates of emergency room visits
related to asthma (Center for Disease Control and Prevention, 2016). Long Beach, CA was
chosen for ACE-LB since it has a significant Hispanic and African American population, areas of
low socioeconomic status, and the ports nearby which cause poor air quality. The third
component is to plan our approach. Interviewing the Director of Community Engagement, Victor
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Ortiz-Luis, gave insight on past techniques that have shown promise in tackling the burden of
Asthma. Home visits are going to be the main intervention of ACE-LB since there have been
programs in Long Beach that have used this method and have shown promise. The fourth
component is to implement our plan using concrete action steps. A major step that needs to occur
in this component is having all community health workers trained on how to effectively conduct
the home visitations. These workers will also be trained on how to properly teach the asthma
education classes. Outlines indicating our goals and assignments that need to be completed for
our program participants will also used to assure that everyone is receiving the same treatment.
The last and extremely important component is to track our progress over time. In order to
ensure that resources are being well spent and our program is reaching its objectives, we will
have an outside evaluator checking the progress over time. Surveys and interviews will be given
to the participants two times after the initial visit as well as one year after the program has come
to an end to determine whether or not they have gone back to the emergency room due to asthma
which is the overall goal of the program.
Behavioral Model
Our program is built on the framework of the Health Belief Model which focuses on
behavior at the individual level. Emergency related asthma attacks are directly affected by
asthma participants who fail to take the proper steps to prevent asthma related flare-ups which is
solely based on the individual's thought process on how to take the proper health-related action.
The health belief model identifies that when a person realizes they are susceptible to a condition
that has a serious consequence, it is in there best interest to gain knowledge on how to move
forward in maintaining the problem. The seven components to the health belief model are, 1)
perceived susceptibility-beliefs about the persons likelihood of having the problem, 2) perceived
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severity- beliefs about how serious the health problem is and its consequences, 3) perceived
threat- overall perception of threat to health, 4) perceived benefits of an action- belief about the
benefits of action to reduce a health threat, 5) perceived barriers to take the action- overall
perception of threat to health, 6) cues to action- information about perceived threat, benefits,
barriers of particular actions and 7) self-efficacy- ones ability to take specific action. This
individual thought process can help prevent severe asthma related attacks and it can also help
patients control their asthma.
Overall Intervention
Reducing asthma attack rates for the desired target population can be achieved through
conducting proper asthma education, demonstrating proper inhaler use, and conducting a house
inspection during a home visit. The three activities will be implemented during each home visit
regarding asthma and how to manage it. There will be a total of three home visits during the
program. The first home visit will contain the bulk of the information and detailed
demonstrations while the subsequent two will act as reinforcement home visits enhancing ideas
and concepts with information regurgitation.
In order to conduct such activities, a variety of resources will need to be utilized to
efficiently execute the desired outcomes. Being limited to a strict budget, proper and necessary
allocation and documentation of resources must be a priority when implementing the following
activities. Different neighborhoods and sub-communities will need a health educator who knows
the language and culture. Ten health educators will be sent to various communities within the
target geographic locations in Long Beach and within each visit, an asthma educator will conduct
a comprehensive, concise, and personal asthma education presentation, proper inhaler and
medication use demonstration, and a house inspection looking for asthma triggering agents.
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Recruitment will be achieved through a variety of mediums in partnership with St. Marys
hospital, the central hospital in the desired geographic location. Since doctors do not have the
time to conduct in-depth education with their patients on asthma, this program can be referred to
patients by doctors to lessen that burden, incentivizing program promotion. Doctors or
respiratory therapists can refer a patient by giving a referral, brochures, flyer, business cards, or
website links of the program. The second recruitment method will consist of interns being sent
into the community to post and pass out flyers in different locations our desired population will
likely be. Some examples may include places near clinics, shopping centers, parks, restaurants,
and community centers. The third recruitment method will involve giving brochures to local
community-based organizations to give to their clients. Other methods of recruitment will
include hospital and clinic waiting room brochures, referrals through a partnership with the
American Lung Association, and booth advertisement at American Lung Association Lung Force
Walks.
Certified Health Educators will be used to conduct the home visitations. When hiring,
previous asthma education training and certification is preferred, but asthma education training
and certification will be provided for all educators prior to program implementation whether or
not they have had it. The training will be conducted through the American Lung Associations
Asthma Educator Institute whose standards and accreditation are an exemplary resource for
meeting the standards of the program. The program is a 2-day course which prepares each
educator with the education and credentials to properly implement the program. After all asthma
educators are certified, based on the testimonies of the key informants, each educator will be sent
to the specified house of the participant who signed up. Educators will be sent based on race and
language to create a comfortable environment for the participant. Each participant will need to
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schedule a time for a home visit that best fits their schedule. Typically, this will be during
evenings after the typical adult work day and on the weekends. Once the educator has been
invited into the home of the participant during the scheduled appointment, they will begin with
an introduction of themselves and the program, giving their credentials. This ensures the
participant that the information provided can be trusted and that the information has importance.
After the introduction, the consent form and a pretest will be administered before the first
activity begins during the first home visit. Each asthma educator will bring with them two
dummy sample inhalers with two standard spacers and two whistle spacers, a visual diagram
board to enforce material, and an information packet for the participant to keep.
Program Activities
Activity 1
Health educators will begin with a formal asthma education activity, given in an
interpersonal, one-on-one lecture fashion, welcoming any dialogue and questions during the
educational segment. The health educator will need to ask the participant to find a comfortable
space to sit where they can be un-interrupted for about two hours. This activity will cover the
basics of asthma including: the definition, burden of asthma in Long Beach, simple
pathophysiology, all risk factors associated with asthma, purpose and uses of different asthma
medicines, asthma prevention applied to participants lives, the importance of proper inhaler use,
how to properly manage asthma in everyday life, the dangers of improper asthma management,
and different triggers to look for in their house. All information needs to be portrayed in simple
and understandable language for best retention by the participant. The visual diagram board,
which will be 3X 3, will have print large enough for the average adult to read. This board will
contain anatomical diagrams, facts, simple charts, and act as a general guideline for the educators
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to reference while educating the participant. It is important that the educator uses the board
during the asthma education activity to better grab the attention of the participants while
enforcing important concepts. Keeping the board facing towards the participants and pointing out
key information is necessary because there are different learning styles among different people
and educators need to be adaptive to these learning styles. All medical jargon will be used
sparingly and is ultimately up to the discretion of the educators as some participants will need
simple language while some can understand complex medical jargon. This ensures that the
information is being retained and understood and will be enforced through dialogue and
questions asked by the participant. By the end of the asthma education activity, the goal is to
increase the participants knowledge of asthma definition and basics, risk factors, prevention, and
how they can apply this knowledge to their own lives, which is directly linked to impact outcome
number one.
Activity 2
Directly following the education activity, the educators will transition into the proper
inhaler usage demonstration activity. This is an important activity because improper inhaler
usage can be a very common issue among those with asthma. The educator will refer back to the
different kinds of medicines used to treat asthma and demonstrate improper versus proper inhaler
use. The resources needed are two dummy inhalers, two standard spacers, two whistle spacers,
and one information packet. Using the dummy sample inhaler without a spacer, the educator will
perform the improper method of inhaler use, and explain why this form is ineffective and will
show a diagram enhancing the concept. The pre-test for the demonstration will consist of a quick
scenario asking the participant to act as if they were using their inhaler and marking on a
checklist the important steps needed to effectively use an inhaler. The health educator will then,
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attach the standard spacer to the inhaler, explain why and how it is used, and demonstrate the
proper way to use an inhaler. It is important to explain that taking deep, slow breaths and holding
it for ten seconds is necessary and why it is necessary. Next, the educator will attach the whistle
spacer to the inhaler, explain how and why it is used and demonstrate the same technique for
proper inhaler use with the whistle spacer. This is important because it gives the participants
options, knowledge to overcome barriers and the freedom to choose inhalers that best work for
them as well as demonstrate how to use those options. After the educator demonstrates the proper
technique for inhaler use, they will assist the participant with practicing their technique three
times using the second dummy inhalers and spacers. Once the educator has determined proper
technique has been achieved, they will review all information one last time, give the participants
an information packet which highlights all key information reviewed in the session and proper
inhaler use, and then address any questions from the participants. By the end of the activity, the
participant will be able to demonstrate proper usage of an inhaler, know how to use and attach a
spacer, know options of spacers available to them, and have received an information packet, all
of which is linked to impact objective two.
Activity 3
The final activity that educators will perform with the participants is a home inspection.
The home inspections objective is to identify any possible asthma triggers within the
participants household, to inform them of other common triggers, and advise them on how to
reduce the risk of an asthma attack from occurring. The educators and participants will go
through each room in the household to analyze the condition of the rooms by examining the
furniture, pipes, as well as find cracks and molds in the home. Following the inspection, the
educators will write a list of the potential asthma triggers within the participants home that needs
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to be addressed and explain how to address them. Then, the educators will instruct the
participants on the importance of: cleaning the home and furniture to prevent dust, dust mites, as
well as mold from accumulating; the need to repair any damaged or leaking pipes to avoid
growths of mold; washing dishes, kitchen appliances, and taking out garbage regularly; bathing
pets regularly; and limiting exposure to tobacco (ACAAI, n.d.). An educational pamphlet of
known household asthma triggers and how to reduce these triggers will be provided at the end of
the inspection. An indoor asthma trigger checklist will be administered at the first home visit and
reinforcement follow-ups to assess whether or not the participants have reduce indoor asthma
triggers. This activity achieves the third impact objective by educating the participants to reduce
asthma triggers within the household.
Volunteer Recruitment
Volunteers will be needed for this program to serve as promotoras. The role of the
promotoras will be to promote and advocate for the program. In order to do that, they too will go
through a short training and learn about the purpose of the program so that when they go out to
sponsor it, they will have accurate information and responses to possible questions. Priority
volunteer opportunities will be given to university students who are health science/public health
majors. Recruitment will occur by visiting local campuses and informing Health Science
students about a new internship opportunity. They will further be primed on the tasks and
qualifications of the opportunity, making clear that they will have to undergo a training, as well
as a pre-test and post-test before and after to monitor the knowledge accumulated during the
training. Volunteers who participate throughout the entire time of advocacy and promotion of the
program will receive a letter of recommendation that could be utilized for future opportunities. In
addition to that, volunteers will get internship hours applicable towards their degree as well as
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significant experience that can added to their rsum. Lastly, as a supplemental token of
appreciation, volunteers will receive a care package that will include a t-shirt and coffee cup with
the program name and logo.
Scope of Work
Timeline: 18 months
Implementation Activity Start-End Who is Tracking Measure

Date responsible
Process Objective #1: During month 1, a meeting will be held with local community
based organizations to get their perspective on asthma in the target population.
10 CBOs agree to participate Start month 1 Health Educators 25 count Project
End month 1 team hired
CBOs contact community leaders Start month 1 Health Educators Confirmation email
End month 2
Start-End Who is Tracking Measure

Implementation Activity Date responsible
Process Objective #2: During month 1, local Community Based Organizations will
distribute 300 flyers and brochures in the target neighborhood to assist in gaining
entry into the community.
Hire project team Month 1 Health Educators Project team
highered
Contact local CBOs Month 1 Health Educators Have a response

email Confirmation
email

Date responsible
Process Objective #3: During month 2, home visits will be scheduled with referred
participants through a phone, email, and website sign up.
Meet with prospective participants Start of Certified Health Sign-in sheet
month 1-end Educators and
of month 2 College interns
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Schedule home visitations for Month 2 of College interns Excel worksheet and
participants with certified health program and volunteers Calendar
educators

Date responsible
Impact Objective #1: Participants will increase their knowledge of signs and
symptoms of asthma attacks by 10% as measured by a pretest at first home visit and
posttest at last home visit from months 3-17.
Home visit educational activity Month 3-10 Health Educator Pre-test
of Program
Reinforcement follow-up #1 Months 11-13 Health Educator Sign-in sheet

of program
Reinforcement follow-up #2 Months 14-17 Health Educator Post-test

Date responsible
Impact Objective #2: Participants will demonstrate how to properly use an inhaler
after receiving detailed instructions by a community health worker as measure by a
pre-test at first home visit and a post-test at last home visit during months 3-17.
Inhaler Demonstration Activity and Month 3-10 of Health Educators Pre-test by
information pamphlet Program standardized rubric
Reinforcement follow-up #1 Months 11-13 Health Educators Sign-in sheet

of program
Reinforcement follow-up #2 Months 14-17 Health Educators Post-test by

of program standardized rubric

Date responsible
Impact Objective #3: Participants will reduce asthma triggers in their household by
15% within months 11-17 from the first inspection to the final inspection as
measured by a checklist.
House inspection Months 3-10 Health Educators Create a checklist
of program on asthma triggers
after first meeting
for follow-up
meetings.
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Reinforcement follow-up #1 Months 11-13 Health Educators Use checklist from

of program first meeting to
assess change since
the first house
inspection. Create
another checklist for
the last follow-up.
Reinforcement follow-up #2 Months 14-17 Health Educators Use the checklist

of program from the first follow-
up to see how
effective the house
inspection activity
was in reducing
asthma triggers at
home.

Date responsible
Outcome Objective #1: Asthma-related emergency room visits will be reduced by

50% among program participants by month 18 of the program.
Home visit #1 Months 3-10 Health Educators Self-report survey
Reinforcement home visit #3 Months 14-17 Health Educator Self-report survey

Date responsible
Outcome Objective #2: In June 2019 at one- year follow up, 75% of participants will
carry their inhaler.
Follow up survey with program June, 2019 Health Educator Self-report survey
participants
Home Visit #3 Month 14-17 Health Educator Self-report survey

of program
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ACE-LB Evaluation Plan
Overall Evaluation
The non-experimental design will be adopted in the ACE-LB program. The non-
experimental design is an appropriate use for the ACE-LB program because of limited resources
which makes it difficult to have a control group and experimental group. Also, since there is no
list to reference, there cannot be randomization. The non-experimental design will include one
group with a pre-test and post-test. The program planners must tailor the program to address
threats to internal validity that the non-experimental design cannot control for. Possible threats to
internal validity are history, attrition, and social desirability.
African American and Latino participants will be recruited through hospital referrals,
Community based organization involvement, and by the flyers posted around the community.
The consent form will be provided to the participants at the first home visit detailing the program
description, benefits, risks, procedures, and participants rights and responsibilities. The
participants must either call, email, or sign up online to inquire for a home visit, which is when
contact locator forms will be completed for each participant. The contact locator form will
include the contact name, address, phone number, email, and possible available times for visits.
Evaluation data will be gathered through pre-and post-tests. The pre-test and post-test
will include all 100 participants and will contain two components: knowledge testing and skills
testing. The pre-test will be implemented at the first home visit before the education activity is
conducted. The post-test will be implemented on the last reinforcement follow-up. The pre-test
and post-test will be conducted in person with the health professional who will be asking and
documenting the questions. The knowledge testing will assess the baseline knowledge on asthma
at pre-test and acquired knowledge at post-test. The knowledge test will evaluate four knowledge
23
concepts: signs and symptoms of asthma, asthma management, asthma triggers and inhaler
knowledge. The knowledge test will account for qualitative and quantitative data. The skills
testing will use a standardized rubric to assess proper inhaler use. The data collected will be
qualitative data coded into quantitative data.
Activities will begin at month three through month seven. The pre-test will be
administered at the first home visit at between months three through ten before the start of the
three activities. The first reinforcement follow-up will occur from months 11 through 13 and the
second reinforcement follow-up will occur from months 14 through 17. The post-test will be
administered at the second reinforcement follow-up. Incentives will be provided and include
inhaler spacers and asthma-safe cleaning products and will be distributed at the first home visit.
Interns and volunteers will contact the participants throughout the program by phone or email
regarding scheduling home visits, program overview, and general questions.
For impact evaluation, the pre-test and post-test will be used and for outcome evaluation,
a survey will be used. They will be both qualitative and quantitative. The impact evaluation pre-
test and post-test will be administered during the home visit, with the health educator present.
Knowledge questions will include true/false and multiple choice questions. Attitude questions
will include questions using a Likert scale and the behavioral question will be a fill in. For
outcome evaluation survey questions, an email or paper letter will be sent out one year after the
program to gather such data.
Process Evaluation
There will be a meeting with local CBOs in order to get ideas and help with recruitment.
The CBOs will be working with children and ACE-LB will target the parents who are dealing
with asthma in order to give them the services they deserve as well. The evaluation will include
24
an email link having the CBOs RSVP to ensure that there is a good turnout. Volunteers will also
call them three days before as a reminder and have a sign in sheet to keep track of which CBOs
have helped. Volunteers will also count the flyers that are being given to ensure that there is
enough flyers to match the sample size goal. The process evaluation will include a sign in sheet
as a method of tracking who has had a home visit as well. The health educator, when visiting a
participant's home, will have a sign in sheet where the participant will sign, confirming the house
visit has taken place. Each participant will have three slots to sign, one for the first home visit,
another for the second home visit, and a third for the last home visit. All test, surveys, sign in
sheets, and responses will be inputted in a database in order to have a reference for all
employees. It is important to include a tracking measure for participant home visits because this
will identify any attrition (participant drop outs). After every cycle of home visits (i.e cycle one
is first round of home visits [months 3-7], cycle two is second round of home visits [months 8-
10]. etc.) an analysis of the sign in sheets will be conducted to determine if there have been any
drop-outs. If a participant has dropped out, volunteers will attempt to contact them and determine
reason for attrition and any barriers that will need to be addressed (flexible scheduling, support,
etc.) Questions will include: What are some reasons for not scheduling or rescheduling a home
visit?, What are some reasons for not following through with home visit appointment?, What
can we here at ACE-LB do to address any problems you may have with scheduling a home
visit?.
Impact Evaluation
Home visits will begin at month three through month seven. The first activity that will be
implemented will be asthma education classes. The education classes will focus on four
components; Signs and Symptoms of asthma, asthma management, and asthma triggers. History
25
is an internal threat of validity that challenges a program by stating that an outside force caused
the change and not the program itself. A limitation that ACE-LB has is the fact that a non-
experimental design does not control for this threat. Despite this, the program coordinator and
volunteers will constantly ask the participants if they have received any other information about
asthma outside of the program and make sure to document everything. In order to assess
knowledge, questions from the Knowledge, Attitudes, and Self-Efficacy questionnaire on asthma
will be given. This questionnaire was designed to allow health professionals to assess asthma
patients knowledge regarding asthma, their attitudes about their asthma, and their self-efficacy
regarding their perceived ability to control the disorder (Wigal et al, 1993). A question that will
address sign and symptoms knowledge will be Which one of the following is not a common
asthma symptom? A)Sore, dry throat B)coughing C)Chest Tightness D)Wheezing (knowledge-
based question). A question that will address knowledge on asthma triggers will be Which of
the following is not a common asthma trigger? A)Weather Changes B)Laughing C)Aspirin
D)Exercise E)Caffeine (knowledge-based question). A sample question that will be used to
address asthma management knowledge will be Following a healthy diet and lifestyle will help
control my asthma. A) Strongly Agree B)Agree C)Disagree D) Strongly Disagree (attitudinal
question). The pre and post test answers will then be given to the evaluator so that a comparison
can be made on the change of knowledge of the program participants.
To assess improvements in creating an asthma safe home, an initial pre-checklist will be
used when conducting a house inspection. This pre-checklist will establish the condition of the
house before any suggestions for improvements are made. A post-checklist will then be used for
second home visit inspection, where it will asses the different asthma safe improvements and
changes made that were suggested at first home visit inspection. At the third home visit, there
26
will be a final house inspection post-checklist to assess overall asthma safe home improvements.
The pre-checklist and post-checklist will be identical, providing areas of inspection to be marked
if they apply to the house. These include: signs of mold growth, damaged faucets, cracks within
the households, old carpets, live plants in the house, dust, cockroach infestations. There will also
be a couple of questions asking if the participants were aware of these risks in their homes,
potentially leading to future areas for interventions. For example, Is there evidence of standing
water or leaks? Yes or No (EPA, 2004).
Outcome Evaluation
One year after the ACE-LB program, a self-administered questionnaire will be distributed
by the volunteers and interns through email and mail to the participants to determine whether or
not the program had 75% of participants carrying his or her inhalers at all times and whether or
not the program had decreased asthma-related emergency room visits by 25% among
participants. The questionnaire will include questions (BRFSS, 2008)
such as How likely are you to carry an inhaler with you at all times? A) Never, B) Almost
Never, C) Sometimes, D) Almost Always, E) Always and How many times have you been
treated in the emergency room for asthma symptoms in the past 12 months? A) List number of
visits, B) None, C) Dont know/Not sure, D) Refused as well as Do you currently have an
Asthma Action Plan in case of an asthmatic emergency? (Behavioral question) Social
desirability states that participants may answer what is considered to be the social norm in order
to fit in. In reference to ACE-LB, participants may feel the need to lie about whether or not they
have been back to the emergency room or whether or not they are carrying their inhaler.
Although a non-experimental design does not control for this threat directly, having staff
members that are part of and have previously worked in the target community will ensure trust.
27
The health educators will be trained on how to make the participants feel welcome and not being
judged. This will in turn reduce the likeliness of the participants needing to lie and tell the truth.
The participants will be able to email or mail back their responses once the questionnaires are
completed.
References
1. 2014 Adult Asthma Data: Prevalence Tables and Maps. (2016, July 13). Retrieved September 08,
2016, from http://www.cdc.gov/asthma/brfss/2014/tableL5.htm

2. Allergy- and Asthma-Proof Your Home. (2016). WebMD. Retrieved 17 November 2016, from
http://www.webmd.com/asthma/allergy-asthma-proof-home
3. Asthma. (2016, June 13). Retrieved September 08, 2016, from
http://www.cdc.gov/nchs/fastats/asthma.htm
4. Asthma's Impact on the Nation. (n.d.). Retrieved September 07, 2016, from
http://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf
5. Asthma Life Skills Academy for Adults (ALSAA) Program. (2013, September 30). Retrieved
September 07, 2016, from http://www.longbeach.gov/health/media-library/documents/healthy-
living/individual/asthma/alsaa/alsaa-cumulative-report-2011-2013/
6. Asthma significantly increases the amount of missed work days among the African American
and Latino population in Long Beach http://www.longbeach.gov/health/media-
library/documents/planning-and-research/reports/community-health-assessment/community-
health-assessment/
7. Australian Centre for Asthma Monitoring (2007) Survey questions for monitoring national
asthma indicators. Retrieved December 6, from
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453784
28
8. Bahadori et al; (2009, May 19).BMC Pulmonary Medicine. Retrieved September 08, 2016, from
http://bmcpulmmed.biomedcentral.com/articles/10.1186/1471-2466-9-24
9. Behavioral Risk Factor Surveillance System (2008) Retrieved from
http://www.cdc.gov/asthma/pdfs/brfssasthmaquestions.pdf
10. Behavioral Risk Factor Surveillance System (2016) Retrieved from
http://www.cdc.gov/asthma/survey/BRFSS_2016_508.pdf
11. California Health Interview Survey (2015. January 8). CHIS 2013-2014 Adult Questionnaire
Version 5.4. Retrieved November 16,2016, from
http://healthpolicy.ucla.edu/chis/design/Documents/chis2013adultquestionnaire.pdf
12. Emotional and Social Effects of Asthma - Health Alliance Blog - Helping You Be Your Best.
(n.d.). Retrieved September 08, 2016, from http://blog.healthalliance.org/disease-
resources/emotional-and-social-effects-of-asthma/
13. Free Asthma Classes, Learn to Control Your Child's Asthma. (2016). Retrieved September 07,
2016, from http://lbaca.org/wp-content/uploads/2013/07/Asthma-Classes2-2016.pdf

14. Gelfand, E.W. (2008) The Impact of Asthma on the Patient, the Family, and Society. Johns
Hopkins Advanced Studies in Medicine, vol. 8. Retrieved from
http://www.jhasim.com/files/articlefiles/pdf/GELFAND-%20Article1.pdf
15. HOME Allergy Management | ACAAI Public Website. (n.d.). American College of Allergy,
Asthma & Immunology. Retrieved October 20, 2016, from http://acaai.org/resources/tools/home-
allergy-management
16. Houston, D. , Li, W. , & Wu, J. (2014). Disparities in exposure to automobile and truck traffic
and vehicle emissions near the los angeles-long beach port complex. American Journal of Public
Health, 104(1), 156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3910024/

17. Milet, M., Lutzker, L., Flattery, J., & Wohl-Sanchez, L. (2013, May). Asthma in California, A
Surveillance Report. Retrieved from
https://www.cdph.ca.gov/programs/ohsep/Documents/Asthma_in_California2013.pdf
29
18. National Hospital Ambulatory Medical care Survey: 2011 Emergency Department Summary
Tables. (2011). Retrieved September 07, 2016, from
http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf
19. School. (n.d.). Retrieved September 08, 2016, from http://lbaca.org/services/school/
20. Speck, A. L., Nelson, B., Jefferson, S. O., & Baptist, A. P. (2014). Young, African American
adults with asthma: what matters to them?. Annals Of Allergy, Asthma & Immunology, 112(1),
35-39. doi:10.1016/j.anai.2013.10.016
21. United States Environmental Protection Agency (2004). Asthma Home Environment Checklist.
Retrieved from https://www.epa.gov/sites/production/files/2013-
08/documents/home_environment_checklist.pdf
22. Van Lieshout, R.J and MacQueen, G. (2008) Psychological Factors in Asthma. Allergy, Asthma,
and Clinical Immunology, volume 4. Retrieved from
http://www.isdbweb.org/documents/file/1267_20.pdf
23. What the ALSAA Program Can Do for YOU!!!! (n.d.). Retrieved September 07, 2016, from
http://www.longbeach.gov/health/media-library/documents/healthy-
living/individual/asthma/alsaa/alsaa-program-fact-sheet/
24. Wingal, J. K., Stout, C., Brandon, M., Winder, J. A., McConnaughy , K., Creer, T. L., & Kotses,
H. (1993). The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire. CHEST Journal.
30
Appendix
Key Informant Interview
Name Of Organization: American Lung Association

Address: 3325 Wilshire Blvd, Ste. 900 Los Angeles, CA 90010
Interviewee: Anthony Ortiz-Luis, Director of Community Engagement
Anthony.ortiz-luis@lung.org 310-735-9180
The American Lung Association has been fighting lung disease since 1904. It originally
started with the main focus on Tuberculosis and has now worked its way into tackling various
lung diseases and topics including COPD, asthma, lung cancer, tobacco, smoke and polluted air.
One of their offices is located in Los Angeles, California, where we had the unique opportunity
of interviewing the Director of Community Engagement, Anthony Ortiz-Luis. He has been
working for the American Lung Association for about a year now, but has been in the public
health field working for nonprofit organizations for over 15 years. He is very passionate about
asthma since his mother, his son, and himself all have it. He has worked with many organizations
on this issue and agrees that it is an issue that is still a problem that needs addressing, especially
in certain areas with high rates such as Long Beach.
Approximately five years ago there was a significant amount of money that was available
for public health officials so they can create public health programs. Asthma was a key issue that
31
a significant amount of attention was put into. There were various programs put in place in areas
that had high and unmanaged asthma rates with Long Beach being one of them. An effort was
put forth in order to make more physicians certified asthma educators. There are currently 440
physicians certified as asthma educators in California compared to the five million people who
are living with asthma. This effort, however, was proven to not be effective. There was no
significant change in asthma management. There was a program that showed promise and
success that came from the Long Beach Department of Public Health. This program, run by
Judeth Luong, was called the Community Asthma and Air Quality Resource Education Program.
Promotoras or health educators would conduct home visits with residents of Long Beach who
had been diagnosed with asthma and were not managing it well. These workers were usually
nearby residents therefore making it easy to earn the communities trust. Eventually, the grant
money ran out and the program had to come to an end. There was a total of anywhere from
5,000-7,000 home visits conducted and extraordinary results were shown. Home visits seems to
be an extremely effective technique to use.
The Public Health Departments and the community-based organizations, Long Beach
Alliance for Children with Asthma (LBACA) and Esperanza Community Housing, are public
health sectors that have been traditionally involved with asthma in Long Beach. Research done
by these public health sectors discovered that the African American and Hispanic communities in
Long Beach have higher risk of asthma than other communities because of the area and
environment the communities are located. The environment of Long Beach contribute greatly
towards the growing asthma problem among these communities. With the substantial air
pollution, warm climate, and traffic on the freeways the air quality is extremely unhealthy and
hazardous to the citizens of Long Beach, especially for the Hispanic and African American
32
population that lives near the ports and freeways. Thus, living in this environment will have an
increased risk of respiratory diseases, including asthma.
Ortiz-Luis and his community believes that asthma is a problem among the African
American and Hispanic population. Despite the asthma problems in the community among low
income individuals and families, there are larger concerns in public health that draws attention
away from asthma. The American Lung Association and other public health sectors are focusing
and allocating more time and resource into other major concerns such as cancer, heart disease,
chronic obstructive pulmonary disease (COPD), and obesity. Therefore, Ortiz-Luis and his
community recognizes asthma among the African American and Hispanic community as a
problem, but need more attention and resources to mitigate the asthma issue.
Anthonys personal perspective about the issue is that, clearly, asthma does need more
attention than it is currently getting. The reason that it is not, he believes, goes back to the
discussion about other chronic diseases, such as diabetes, obesity, and cardiovascular problems
because such diseases have higher fatality rates than asthma. Other barriers that were discussed
included funding, environmental factors, and the fact that there are different hospital systems in
Long Beach. Long Beach has dignity health such as St. Mary Medical Center, memorial care
system such as Millers Children and Womens Hospital, and the Long Beach Clinic which is run
by the city. These three distinct systems serve different portions of the population and have very
limited communication between one another which makes keeping track of readmissions of
asthmatics difficult. For example, if a patient comes into the ER due to asthma complications,
his/her primary care physician might not be informed of the situation because of this limited
communication between the different systems. If that issue was solved and there was open
communication, patients with asthma would be easily identified whenever they came into an
33
emergency room and resources for them would be more obtainable. However, until the
coordination issue is resolved, there will be insufficient knowledge on where the areas with high
asthma rates are and less resources available.
Overall, we can take away several things from this interview. The two main things,
though, are that we now have more knowledge on previous programs that have shown
effectiveness and that we also have a better understanding of the perceived barriers to resolving
the issue of asthma among African American and Hispanic adults in the city of Long Beach.
Marketing Strategies
E-Flyer
34
Flyer
Come Join
Asthma Control and Education in Long
Beach
When: March 1st, 2017
Do you struggle
with asthma?
Become a participant
for free!
Who: We are currently looking for
Hispanic or African American
participants aged 25-55 who reside in
Long Beach and are currently
struggling with asthma.
What: Our professional health

educators will meet you in the
comfort of your own home to help you
learn to manage the difficulties that
come with asthma. You will grasp the
knowledge, skills, and techniques necessary to keep your lungs happy and healthy.
Our health educators will show you how easy it can be to manage your asthma and
get you back to doing what you love. The home visits will consist of a quick mini
lesson, demonstration, and asthma trigger inspection.
Where: Since we will meet you in your beautiful home, all that is needed it an
appointment.
Contact:
Phone: (562)-555-LUNG
Email: asthmafree@acelb.net
35
Website: www.acelb.co
Brochure
Budget
36
Budget Justification
The Asthma Control and Education in Long Beach (ACE-LB) program is a non-profit
with the goal of reducing the number of asthma related emergency room visits amongst its adult
African American and Hispanic participants aged 25-55 in Long Beach. The ACE-LB program
has a budget of $300,000 to achieve its goals and objectives.
Personnel
37
The project coordinator will be in charge of creating the program by gathering and
analyzing data, creating a needs assessment, selecting a health condition (asthma), population
group, and a geographic location where the program will be implemented. The project
coordinator will also be in charge of the recruitment methods that will take place to reach the
target population as well as designing the interventions that will be used in the program. St. Mary
Medical Centers Emergency Department will be in contact with the project coordinator in order
to give a list of the participants that are being referred to ACE-LB. In order to ensure that the
program goals and objectives are being met efficiently, close work with the external evaluator
will also be a key role of this position. This position will be in charge of all health educators and
volunteers and will ensure that everyone is properly trained and following the regulations set
forth by the program. Any conflicts or concerns will be given to and handled by the project
coordinator as well.
Since this position of a project coordinator requires experience, dedication, and
discipline, the mandatory qualifications will be a Masters degree in Public Health, 1 year of
project coordinator experience, and Certified Health Education Specialist certification. Strongly
recommended qualifications will include being bilingual (English and Spanish), and being
familiar with the Long Beach Area as well as having already worked with the target population
in previous programs. The project coordinator will receive a salary of $56,000 a year. Since
ACE-LB is an 18 month program, the total salary will be $84,000. With the benefits included,
health insurance, dental insurance, vacation, sick pay and retirement, the total amount paid for
the Project Coordinator will be $111,720.
Certified Health Educators will also be vital in ensuring that ACE-LB is a success. These
educators will be in charge of conducting the home visits with the program participants. Training
38
will be offered through the American Lung Association in order to ensure that all educators have
the proper level of competence. This will also help ensure that all participants will be receiving
the same information. All educators will be reporting to the program coordinator and evaluator
when necessary. The main tasks of theses educators will be to conduct the home visits which will
include presentations, demonstrations, and a house inspection, as well as properly keeping track
of the participants progress in order to report back to the coordinator and evaluator. These
educators will be in charge of administering, collecting, and documenting the tests and practical
demonstrations and forwarding these to the Evaluator and Program Coordinator. This will consist
of a significant amount of communication with the program coordinators and the program
participants.
There will be a total of four Health educator positions. The qualifications will be CHES
certification, bilingual in English and Spanish, and at least six months of public health
experience in a similar setting. Living in or having experienced working in the target area is
desirable. Since the health educators will be going into the participants homes it would be more
practical if they live in the target area. This will hopefully encourage trust with the participants.
These positions will be part-time and will be receiving a salary of $28,800 each with a grand
total of $115,200 paid for all of the certified health educators.
In order to remain within the budget, the help of college interns will be strongly needed.
The interns will be assisting the program coordinator in public outreach and recruiting
participants by handing out flyers and preparing the meetings with the CBOs ensuring all
supplies needed are available. College interns will also play a vital role in coordinating the home
visitations by working directly with the participants and health educators and scheduling the
appropriate home visits. Reaching out to program participants prior to their scheduled home visit
39
will be essential in ensuring resources are not being wasted. This will prevent missed
appointments and allow participants to reschedule if necessary without wasting the health
educators time. Apart from gaining valuable experience in a public health setting, the interns will
be compensated for their work by receiving documented internship hours that can be used for
school as well as a letter of recommendation from the program coordinator. Upon the completion
of the program, a $100 visa gift card will be given to the interns as a token of appreciation for
their service. 10 interns will be hired, therefore $1,000 will be spent on the visa gift cards.
Consultants
The program evaluator will cooperate with the project coordinator, health educators,
volunteers and interns to collect information on the implementation, effectiveness, efficiency,
and cost-effectiveness of the ACE-LB program. With the project coordinator, the evaluator will
evaluate the implementation of activities, allocation budget and resources, as well as delegation
of tasks to the health educators, volunteers, and interns. Once the program begins, the evaluator
must gather information from the health educators to assess the efficiency and effectiveness of
the home visits and the follow-ups. Then, the evaluator needs to collect data on volunteers and
interns to determine the efficiency and effectiveness of program advertising, recruiting, and
community meetings. With information from all parts of the ACE-LB program, the evaluator can
inform the program coordinator where to make adjustments to improve the program so ACE-LB
can succeed. The program evaluator is an essential part of the ACE-LB program and will work
part-time, 20 hours a week from the first month to the eighteenth month of the program.
Therefore, the salary will be $35,333 per year, which will yield an entire 18 month project salary
of $53,000 and will not receive benefits due to part-time status.
Supplies/Expenses/Equipment
40
The ACE-LB program has components within it which will require a variety of supplies,
expenses, and equipment to conduct its day-to-day operations. While a significant portion of the
budget has been allocated towards personnel and consultant salary, a portion must also be set
aside for costs miscellaneous expenses. This portion of the budget will be split up into three
parts: supplies, expenses, and equipment. The total for the entire supplies, expenses, and
equipment budget is $20,000.
A variety of supplies will be essential to keeping the program running efficiently. Printing
supplies, which will be budgeted at $800, are important for creating flyers, documents,
educational pamphlets, and other miscellaneous items needed to be printed. This will include
items such as paper, printers, and ink. Educational supplies, which will have a budget of $2,000,
are the essential to the educational component of the programs home visits. Included are items
such as any poster boards, lamination, folders, carrying carts, clipboards, dummy inhalers,
spacers, and easels. Incentives, with a budget of $1,500, are necessary to draw participants into
the program and keep them from dropping out after enrolled. Items such as asthma safe air
fresheners for their home and asthma safe cleaning products to reduce indoor air pollution ill be
gifted after the first home visit. Promotional and advertisment supplies will include any items
needed to raise awareness of the program and will have a budget of $1,500. This will include
items such as printed flyers, brochures, and business cards, and pens. A food and beverage
budget at $300, for meetings and the CBO conference, will provide attendents with refreshments
and a complimentary snack. Any other miscellaneous supplies will have a budget of $1,500, this
will include items that are not directly correlated with any specific category, but will be
necessary for the program.

41
The ACE-LB program will include many different expenses which will be budgeted to
ensure allocation of monetary resources are used to their full extent and are of a necessity to the
program. Telephone services, which will have a $2,000 budget, act as the main line between
management and its employees, and between management and the participants. For meetings and
gatherings, a conference hall will have a $1,700 budget, which will be used every month from
the start of the program planning to the end of the program. This will ensure that all employees
are kept on up to date on training and expectations within the program. Every health educator
must be certified by the National Asthma Educator Certification Board (NAECB) through
examination which will require training. The training for all health educators will cost around
$1,125 while the actual NAECB certification exams will cost $1,500. Having certified health
educators provides our program with reliability which is essential to program success. Since the
program will not have dedicated office space, online software will be needed to connect
colleagues to collaborate with each other and to keep track of tasks and objectives throughout the
duration of the program. The software budget will be $1,000, which will include all software
download expenses for employees. A well maintained website is important for a program to
convey information to interested future participants in the recruiting phase, and to keep
participants in-the-know during the program. A website budget will have a $375 budget and will
include any maintenance or website fees necessary. Moreover, an advertising budget will also be
necessary to gather participants for the study. This $1,200 budget will include costs such as
social media advertisements and radio advertisements. All travel will be compensated at the end
of the month on the employee's paycheck. A total of $0.50 per mile will be granted, leaving a
travel budget of $2,000. A miscellaneous expenses budget of $1,000 will cover any costs that
were not specified in an expense category, but will be needed for overall program function.
42
Rental equipment is used by the ACE-LB program vary scarcely, but will need to be
budgeted for regardless. Rental chairs and tables for the local CBO meeting will have a budget of
$500. If there are any other rental equipment expenses, the money will be borrowed from
leftover miscellaneous supplies or expenses budget.
Sample survey questions
2008 BRFSS Asthma Questions

1. Have you ever been told by a doctor, nurse, or other health professional that you have asthma?
a. Yes
b. No
c. Dont know/ Not sure
d. Refused
2. Do you still have asthma?
a. Yes
b. No
d. Refuse
Module 9: Adult Asthma History (If yes to question 1)
43
Previously you said you were told by a doctor, nurse or other health professional that you had
asthma.
1. How old were you when you were first told by a doctor, nurse, or other health professional that
you had asthma?
a. ___ age in years if 11 or older
b. Age 10 or younger
d. Refused
2. During the past 12 months, have you had an episode of asthma or an asthma attack?
a. Yes
b. No (go to question 5)
c. Dont know/ Not sure (go to question 5)
d. Refused (go to question 5)
3. During the past 12 months, how many times did you visit an emergency room or urgent care
center because of your asthma?
a. ___ Number of visits
b. None
d. Refused
4. [If one or more visits to question 3, fill in Besides those emergency room or urgent care
center visits,] During the past 12 months, how many times did you see a doctor, nurse or other
health professional for urgent treatment of worsening asthma symptoms?
a. ___Number of visits
b. None
d. Refused
5. During the past 12 months, how many times did you see a doctor, nurse or other health
professional for a routine checkup for your asthma?
a. ___Number of visits
b. None
d. Refused
6. During the past 12 months, how many days were you unable to work or carry out your usual
activities because of your asthma?
a. ___Number of days
b. None
d. Refused
7. Symptoms of asthma include cough, wheezing, shortness of breath, chest tightness and phlegm
production when you dont have a cold or respiratory infection. During the past 30 days, how
often did you have any symptoms of asthma?
a. Not at any time (go to question 9)
b. Less than once a week
c. Once or twice a week
d. More than 2 times a week, but not every day
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e. Every day, but not all the time

f. Every day, all the time
g. Dont know/ Not sure
h. Refused
8. During the past 30 days, how many days did symptoms of asthma make it difficult for you to
stay asleep?
a. None
b. One or two
c. Three to four
d. Five
e. Six to ten
f. More than ten
g. Dont know/ Not sure
h. Refused
9. During the past 30 days, how many days did you take a prescription of asthma medication to
PREVENT an asthma attack from occurring?
a. Never
b. 1 to 14 days
c. 15 to 24 days
d. 25 to 30 days
e. Dont know/ Not sure
f. Refused
10. During the past 30 days, how often did you use a prescription asthma inhaler DURING AN
ASTHMA ATTACK to stop it?
a. Never (include no attack in past 30 days)
b. 1 to 4 times (in the past 30 days)
c. 5 to 14 times (in the past 30 days)
d. 15 to 29 times (in the past 30 days)
e. 30 to 59 times (in the past 30 days)
f. 60 to 99 times (in the past 30 days)
g. 100 or more times (in the past 30 days)
h. Dont know/ Not sure
i. Refused
Knowledge, Attitude, and Self-efficacy Asthma questionnaire
1. Which one of the following is not a common asthma symptom?
a. Sore, dry throat
b. Coughing
c. Chest tightness
45
d. Wheezing
e. Shortness of breath
2. Which one of the following statements is true?
a. Asthma can be the result of an emotional illness
b. People bring asthma on themselves
c. Asthma is the result of how children are raised
d. Asthma is a physical illness
e. Both A and D
3. Air needs to be ____________________ before it reaches the lungs
a. Warmed
b. Humidified
c. Cooled
d. B and C
e. A and B
4. Which of the following is not a common asthma trigger?
a. Weather changes
b. Laughing
c. Aspirin
d. Exercise
e. Caffeine
5. The number of people with asthma in the United States is approximately __________:
a. 10 million
b. 5 million
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c. 3 million
d. 1 million
e. 200,000
6. Which one of the following statements is false?
a. The best time to treat an attack is before it starts.
b. The longer you wait to treat an attack after it begins, the more likely the attack is to
clear.
c. Modifying your activities, drinking clear liquids, and using your inhaler will help
clear an attack.
d. An attack can be treated before it begins by paying attention to your medications, the
environment, your asthma triggers, your early warning signs, and your health habits.
7. When I have an asthma attack and have no idea what caused it, I may
have_______________:
a. Failed to take my asthma medications
b. Unknowingly come into contact with one of my triggers
c. Been experiencing a great deal of stress lately
d. Been unaware or ignored my early warning signs
e. All of the above
8. Which of the following may actually make an asthma attack worse?
a. Continuing to exercise or work once an attack begins
b. Resting instead of remaining active to clear the mucus
c. Pursed-lip breathing techniques
d. Drinking warm liquids

47
e. Using a bronchodilator during the attack
9. The cause of exercise-induced asthma is ____________________________:
a. Cooling and drying of the airways
b. Overheating of the airways
c. Not taking in enough oxygen
d. Not being able to rid the lungs of carbon dioxide fast enough
e. Build-up of lactic acid
10. Which one of the following indicates that your inhaler is empty ?
a. The inhaler stands up at the top of the water
b. The inhaler lays flat on the bottom of the water
c. The inhaler floats on its side on top of water
d. The inhaler stands up on the bottom of water
Asthma checklist
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Running head: ASTHMA CONTROL AND EDUCATION IN LONG BEACH

Asthma Control and Education in Long Beach

California State University, Long Beach

Problem of Justification and Needs Assessment: Jason Levalle

Program Goals and Objectives: Imani Moses

Key Informant Interview: Valeria Macias

Implementation Program: Harry Ta

Scope of Work:Jorge Guerrero

Budget and Budget Justification: Jason Levalle

Evaluation Plan: Imani Moses

Marketing/Recruitment/Promotion: Jorge Guerrero

Problem Justification and Needs Assessment

the emergency room as their primary treatment center for asthma.

uses(Li et al., 2014, para.19).

California, that number is 20.8%, compared to 12.6% in Caucasians (CDC, 2016).

Social Consequences of Asthma

and race and ethnicity cross.

Current Solutions to the Problem

achieve that goal.

attending a certain school or bringing their inhaler.

to consider when formulating such a program.

ideas will be considered when creating a program.

a few demonstrations of non-toxic cleaning methods. As a result of the program, 84% of

program (ALSAA, 2013).

A suggestion to gain more participants in the program is to conduct more workshops at

lasting economic and social benefits.

Program Goals and Objectives

perspective on asthma in the target population.

in the target neighborhood to assist in gaining entry into the community.

or website sign up.

by a community health worker during months 3-17.

first inspection to the final inspection as measured by a checklist.

month 18 of the program.

Program Model Theory

which is the overall goal of the program.

patients control their asthma.

and concepts with information regurgitation.

In order to conduct such activities, a variety of resources will need to be utilized to

patients by doctors to lessen that burden, incentivizing program promotion. Doctors or

community-based organizations to give to their clients. Other methods of recruitment will

of which is linked to impact objective two.

asthma triggers within the household.

the program name and logo.

Implementation Activity Start-End Who is Tracking Measure

Start-End Who is Tracking Measure

Contact local CBOs Month 1 Health Educators Have a response

Implementation Activity Start-End Who is Tracking Measure

Implementation Activity Start-End Who is Tracking Measure

Reinforcement follow-up #1 Months 11-13 Health Educator Sign-in sheet

Reinforcement follow-up #2 Months 14-17 Health Educator Post-test

Implementation Activity Start-End Who is Tracking Measure

Reinforcement follow-up #1 Months 11-13 Health Educators Sign-in sheet

Reinforcement follow-up #2 Months 14-17 Health Educators Post-test by

Implementation Activity Start-End Who is Tracking Measure

Reinforcement follow-up #1 Months 11-13 Health Educators Use checklist from

Reinforcement follow-up #2 Months 14-17 Health Educators Use the checklist

Implementation Activity Start-End Who is Tracking Measure

Outcome Objective #1: Asthma-related emergency room visits will be reduced by

Reinforcement home visit #3 Months 14-17 Health Educator Self-report survey

Implementation Activity Start-End Who is Tracking Measure

Home Visit #3 Month 14-17 Health Educator Self-report survey

ACE-LB Evaluation Plan

internal validity are history, attrition, and social desirability.