Interventions to enhance the adoption of asthma self-management behaviour in the South Asian and African American population: a systematic review

Abstract

South Asian and other minority communities suffer poorer asthma outcomes, have a higher rate of unscheduled care and benefit less from most existing self-management interventions when compared to the majority population. Possible reasons for these differences include failure to implement asthma self-management strategies, or that strategies implemented were inappropriate for their needs; alternatively, they may relate to the minority and/or lower socioeconomic status of these populations. We aimed to synthesise evidence from randomised controlled trials for asthma self-management in South Asian and Black populations from different sociocultural contexts, and identify barriers and facilitators to implementing self-management. We systematically searched eight electronic databases, and research registers, and manually searched relevant journals and reference lists of reviews. Seventeen trials met the inclusion criteria and were analysed narratively. We found two culturally targeted interventions compared to fifteen culturally modified interventions. Interventions used diverse self-management strategies; education formed a central component. Interventions in South Asian and African-American minority communities were less effective than interventions delivered in indigenous populations in South Asia, though the latter trials were at higher risk of bias. Education, with continuous professional support, was common to most interventions. Facilitators to asthma self-management included: ensuring culturally/linguistically appropriate education, adapting to learning styles, addressing daily stressors/social support and generic self-management strategies. In conclusion, when developing and evaluating self-management interventions aimed at different cultures, the influence of sociocultural contexts (including whether patients are from a minority or indigenous population) can be important for the conceptualisation of culture and customisation of self-management strategies.

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

“…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 Our findings not only confirm the clinical benefit of supported self-management for adults, adolescents, and children with asthma but provide practical guidance for models of service that are likely to be effective. Future research and policy investments should focus on implementing regularly supported self-management offering regular reviews totalling at least two hours to establish self-management skills.…”

“…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. 61 …”

Delivery of the UN Convention on the Rights of the Child in an acute paediatric setting: an audit of information available and service gap analysis

“…The outcomes of our study agree with previous publications,12 33 34 regarding resources and information valued by children, parents and staff, confirming these needs are universal, bridging cultural and geographical divides. Resources should focus on the end user, using adaptive formats to effectively meet patient needs 35–38. Professional communities should develop greater health literacy responsive organisations39 ensuring equity of access to resources, differentiation of content according to age, narrative and written competence; adapt to any specific learning needs, thus fulfilling CRC requirements.…”

Epidemiología del asma en adultos. Una visión introspectiva

“…In developing, customizing and evaluating self-management interventions for different cultures, sociocultural factors should be taken into account. 360…”