335 - Identifying strategies to reduce chronic school absenteeism among elementary students with asthma: a participatory approach

Publication Number: 2324.335

Sarah D. Ronis, University Hospitals Rainbow Babies and Childrens Hospital, Cleveland Hts, OH, United States; Marie Masotya, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Sarah Frischmann, UH Rainbow Center for Child Health & Policy, UH Rainbow Babies & Children’s Hospital, Cleveland Ohio, Cleveland, OH, United States; Bethany Snyder, Case western reserve university, Hershey, PA, United States; Peter S. Hovmand, Case Western Reserve University, Cleveland, OH, United States

Background: Chronic school absenteeism among children with asthma is multifactorial in etiology, increases risk for adverse outcomes, but is challenging to disrupt.

Objective: To identify community-endorsed factors associated with chronic school absenteeism and opportunities for intervention.

Design/Methods: Participatory systems dynamics modeling approach including key informant interviews, group model building workshops, and simulation development (table 1). Reference modes were derived from school records and medical claims data. Interviews were audio-recorded, professionally transcribed, and analyzed using a directed content approach, while workshops were documented via photographs and field notes which were digitized and synthesized using Stella Architect. Findings were member-checked with workshop participants and used to delineate intervention options for selection by implementation partners, while simulation was used to forecast needed resources for implementation.

Results: Of 59 community members invited to participate, 29 attended at least one session (13 parents, 6 educators or school nurses, 6 healthcare professionals, 4 public health providers). The synthesized causal loop diagram (`CLD`, figure 1) generated from workshop 1 represented five major domains, including four themes also present in interviews (healthcare access, family social drivers of health, communication with school, local climate/environment), and a fifth theme that emerged in only in group conversations (legal considerations/fear of truancy). Proposed action ideas (table 2) addressed multiple regions of the CLD, with the bundles of "Strategies to improve families' confidence that their students can access and use their rescue medication in a timely fashion" and "Strategies to improve communication between families clinicians and school staff" were deemed to be most feasible and acceptable for pilot implementation.

Conclusion(s): The community-endorsed synthesized CLD expanded partners' understanding of the contributors to chronic school absenteeism among children with asthma, elevating proximal outcome measures and mediating factors not previously considered but deemed essential by community members, directly informing selection of candidate action ideas for further development. Future research should attend to the impact of selected strategies on family confidence in schools' readiness to care for their students with asthma and quality of communication regarding asthma among family, school, and healthcare team members.

Table 1. Overview of group model building workshops and scripts


Figure 1. Causal loop diagram from synthesized connection circles


Table 2. Action ideas proposed during Workshop 2
Non-italicized text is transcribed verbatim from workshop participants. Italicized text represents synthesis and interpretation by research team.