Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Robin S. Everhart, PhD

Second Advisor

Rosalie Corona, PhD

Third Advisor

Suzanne E. Mazzeo, PhD

Fourth Advisor

Michael A. Southam-Gerow, PhD

Fifth Advisor

Michael S. Schechter, MD, MPH


Pediatric asthma disproportionately affects children living in urban areas and within families reporting an income below the poverty threshold. Home interventionist models of care, utilizing interventionists from the communities they serve, have been found to improve pediatric asthma symptoms and reduce Medicaid costs. Home interventionists, such as community health workers (CHWs) and Healthy Homes assessors (HHAs), focus on connecting care among schools, providers, and homes, and empowering families in accessing resources to overcome barriers to care. However, research is just beginning to understand how home interventionists create positive change among families within low-income, urban communities. This dissertation study used a qualitative data approach outlined in the author’s NHLBI-funded F31 training grant (PI: Dempster, F31HL158196) and secondary data analysis of an NHLBI-funded Asthma Empowerment grant that tested a randomized clinical trial of the community-based asthma program, RVA Breathes (PI: Everhart, U01HL138682).

Participants in RVA Breathes identified predominantly African American or Black, resided in public housing, and reported an income below $25,000 a year in Richmond, VA. This mixed-methods dissertation examined the processes by which interventionists in RVA Breathes assisted families in managing their children’s asthma control over an 18-month period. Session notes and internal records from the RVA Breathes intervention were qualitatively analyzed in conjunction with caregiver and interventionist focus groups. Secondary data analyses used multilevel modeling to assess associations among caregiver stress, depressive symptoms, stressful life events, barriers to care, and asthma control over 18-months controlling for group assignment.

Findings highlighted the positive impacts of RVA Breathes on families of children with asthma, even in the face of COVID-19. Caregivers and interventionists also provided recommendations for future intervention efforts. Quantitative analyses found improvements in caregiver stress, depressive symptoms, stressful life events, barriers to care, and asthma control over time. Using multilevel modelling, improvements in caregiver stress and stressful life events were associated with improvements in asthma control over time regardless of group assignment. Findings highlight the benefits of the RVA Breathes program for families of children with asthma and provide evidence for future models of care incorporating home interventionists.


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