Navigating community health: An intervention for low-income asthmatic adults adapted due to COVID-19

RATIONALE: Asthma disproportionately affects low-income and minority adults who are mostly women. The Helping Asthma Patients-3 (HAP-3) Study is designed to engage patients and reveal where health disparity gaps could be reduced. During the intervention, all participants work with a Community Health Navigator, who prepares participants for clinic visits, attends visit while taking notes, and after the session reviews care recommendations with participants. Half of participants are randomized to receive home visits by Navigators, where clinic recommendations are reviewed;health goals are discussed and reported to the patient's clinician. When COVID-19 pandemic forced a widespread shut-down, we were in the 8th month of recruitment and ontarget to reach our enrollment goals for adults with uncontrolled asthma living in low-income neighborhoods. During this unprecedented event, the target community was also traumatized by nationwide episodes of police brutality, hate crimes, and gun violence. With the shutdown and local civil unrest, enrollment slowed. Our goal is to boost enrollment and maintain retention. METHODS: Using a community-based participatory approach, the role of the Community Health Navigator was adapted to boost recruitment, engage participants, and keep clinicians informed of implementation changes, while maintaining the original aims. Using an iterative process with daily huddles of the Navigators and weekly meetings of the Navigators and other team members, including community participants, the protocol was adapted. RESULTS: Over the nine months since the shutdown, we enrolled 73 patients, 60 clinic visits, and 39 number of home visits. We achieved approximately 50% of our original target recruitment goal. We implemented the following innovative adaptations to facilitate enrollment and retention: 1) developed the option of virtual visits for clinic and homes;2) created IRB-approved questionnaires to assess the impact of the pandemic on participants' asthma, general health, and well-being;3) recruited two additional clinics;4) surveyed the impact of social determinants of health on participants;5) standardized our approach to patients;and 6) convened our Community Advisory Board for feedback on adaptations. We improved participant and provider communications through news briefs and fliers, and maintained our presence in clinical offices through in-person and virtual office visits. CONCLUSION: In clinical research, especially of lowincome vulnerable communities, natural events can influence the research and require adaptation of the protocol to preserve its mission. The role of Community Health Navigators is integral in the innovative adaptation of community-based research to capture the needs of patients and inform clinicians.