Decreasing Asthma-Related Health and Educational Inequity Through School-Based Health Services.

BACKGROUND

Asthma is one of the most common chronic diseases of childhood and is a driver of significant health and educational inequity. Despite research demonstrating that school-based asthma interventions can improve health and educational outcomes and advance equity, calls to shift the field to a dissemination and implementation focus have gone largely unanswered.

CONTRIBUTIONS TO THEORY: Building upon the foundation of Charles Basch's 2011 "Healthier Students are Better Learners" framework, we summarize relevant findings from the recent literature on school-based asthma interventions. Two key evidence-based practices: nurse-led care coordination and school-based asthma care delivery, are identified. Application of the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation science framework highlights inadequate school health infrastructure as the major barrier to systematic, comprehensive implementation of these approaches.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Policy solutions should prioritize the goal of at least one nurse in every school. Systematic yet flexible approaches support comprehensive school-based programs tailored to the local context. Attention to compliant information sharing systems and engagement of youth and families is critical.

CONCLUSION

Effective, equity-promoting school-based asthma interventions exist. Adequate school health infrastructure is needed for systematic implementation and large-scale impact. Implementation-science frameworks like EPIS can guide these efforts.