IMP2ART systematic review of education for healthcare professionals implementing supported self-management for asthma

Abstract

Despite a robust evidence base for its effectiveness, implementation of supported self-management for asthma is suboptimal. Professional education is an implementation strategy with proven effectiveness, though the specific features linked with effectiveness are often unclear. We performed a systematic review of randomised controlled trials and controlled clinical trials (published from 1990 and updated to May 2017 using forward citation searching) to determine the effectiveness of professional education on asthma self-management support and identify features of effective initiatives. Primary outcomes reflected professional behaviour change (provision of asthma action plans) and patient outcomes (asthma control; unscheduled care). Data were coded using the Effective Practice and Organisation of Care Taxonomy, the Theoretical Domains Framework (TDF), and Bloom’s Taxonomy and synthesised narratively. Of 15,637 articles identified, 18 (reporting 15 studies including 21 educational initiatives) met inclusion criteria. Risk of bias was high for five studies, and unclear for 10. Three of 6 initiatives improved action plan provision; 1/2 improved asthma control; and 2/7 reduced unscheduled care. Compared to ineffective initiatives, effective initiatives were more often coded as being guideline-based; involving local opinion leaders; including inter-professional education; and addressing the TDF domains ‘social influences’; ‘environmental context and resources’; ‘behavioural regulation’; ‘beliefs about consequences’; and ‘social/professional role and identity’. Findings should be interpreted cautiously as many strategies were specified infrequently. However, identified features warrant further investigation as part of implementation strategies aiming to improve the provision of supported self-management for asthma.

Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis

“…Implementation remains challenging. Pressures of time, organisational barriers, 53 and the need to develop professional skills, 54 as well as negative views about the usefulness of action plans, 55 56 57 are barriers to adoption of supported self-management into routine clinical practice. Our findings suggest that initiatives that facilitate regular review (including mobile phone and internet interventions), 58 ensure that reviews are appropriate (for example, to cultural needs), 59 or involve non-medical or peer support 60 may offer promise for future implementation and research endeavours.…”

Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

“…All these are modifiable barriers. Team-based, comprehensive training of HCPs including nurses, assistant medical officers, and assistant pharmacists in performing-or supporting-asthma self-management counselling may not only facilitate asthma self-management 13,[29][30][31][32] but also help overcome the resource limitations. Only some HCPs were able to attend the structured training relating to asthma self-management in the hope that they would share their learning with their peers who had stayed back to carry out clinic duties.…”

Understanding how patients establish strategies for living with asthma: a qualitative study in UK primary care as part of IMP2ART

“…18 The authors acknowledge that the behaviours identified in this study may not meet the health psychology definitions of 'habit'. Nonetheless, habit formation has been demonstrated as beneficial in recognising and addressing behaviour change in long-term conditions, 9 and was found to be a useful theory to help interpret the present findings and offer practical implications for how to optimise the delivery of supported self-management.…”

“…19,26 For example, strategies offering advice in how (not just why) to change habitual behaviour 19 and avoiding contextual cues that trigger a 'bad' habit are widely recommended, 26,29 but the success of these approaches in the context of SABA use will require further research. The importance of training healthcare professionals to use behaviour change techniques has already been demonstrated; 9 data from the present…”

“…7 For success, practices have to embrace supported self-management within their routines, 8 and professionals need the appropriate skills. 9 Though effective self-management interventions include provision of action plans as a core component 3,10 they are poorly implemented in practice, 11,12 and there is concern that professionals' clinical focus on action plans does not match the advice patients want about 'living with asthma'. 13 As part of the IMPlementing IMProved Asthma self-management as Routine (IMP 2 ART) programme of work, the authors aimed to explore how patients and carers develop and establish their self-management strategies Understanding how patients establish strategies for living with asthma: a qualitative study in UK primary care as part of IMP 2 ART…”