From: Systematic meta-review of supported self-management for asthma: a healthcare perspective
Group | Key strategies | Description of tailoring of self-management intervention | Relevant systematic reviews/update RCTs | Evidence |
---|---|---|---|---|
Cultural groups | Cultural tailoring | Culturally orientated self-management programmes including individual sessions with language-appropriate asthma educators, videos/workbooks featuring culturally appropriate role models, education appropriate to socioeconomic context, strategies for use of local healthcare services, asthma action plans. | **Bailey 2009 [25] Adults and children from minority groups | Culture-specific programmes are more effective than generic programmes in improving QoL, knowledge and asthma control but not all asthma outcomes. |
Culturally tailored, community-based interventions in which healthcare providers (pharmacists, asthma educator, social workers, respiratory nurses) provided language-appropriate education programmes including health literacy-focused teaching, use of videos, asthma physiology and management, inhaler technique, PAAP. | ***Press 2012 [46] Adults from minority groups in the USA | The 5 (of 15) education studies that were culturally tailored showed reduced use of unscheduled care and improved QoL, but this is not compared to non-tailored interventions. | ||
Internet-based programme developed to deliver education and a behaviour change intervention to African-Americans adolescents. Strategies include voice-overs to accommodate literacy limitations and advice delivered by a ‘disc jockey’. | (RCT) Joseph 2013 [54] Young teens | The intervention reduced symptom-free days but had no effect on A&E visits/hospitalisations. | ||
Community workers | Community health worker from the same/very similar community as participating families provided individually tailored education at home visits. Topics included asthma, lifestyle and trigger avoidance, with resources to reduce allergen exposure and smoking cessation support. | **Postma 2009 [35] Ethnic minority children with asthma | Interventions involving community health workers reduced emergency and urgent care use in some but not all studies. | |
Indigenous healthcare workers provided personalised, child-friendly, culturally appropriate education materials at home visits to reinforce clinical consultations. | **Chang 2010 [29] Ethnic minority children with asthma | The involvement of indigenous healthcare workers in asthma programmes (1 RCT) improved control and QoL but not unscheduled care. | ||
A&E attendees | Education during the A&E attendance | Education sessions conducted by asthma or A&E nurses, or, less often, respiratory specialists or a physiotherapist. Content varied, usually including triggers, PAAPs and/or inhaler technique. | ***Tapp 2007 [38] Adult A&E attendees | Education delivered in A&E reduced subsequent hospital admissions but not A&E attendances. Effect on QoL was inconsistent. |
PAAP, completed by the A&E physician, coupled with the prescription provided on discharge from A&E. | (RCT) Ducharme 2011 [50] Children 1–17 y, A&E attendees | Provision of a PAAP increased patient adherence to steroids (oral/inhaled), and improved asthma control. | ||
Education after A&E | Education delivered by a healthcare professional or asthma educator shortly after an A&E attendance, including triggers and PAAPs, to the child and their carers. | ***Boyd 2009 [27] Children, A&E attendees | Asthma education reduced A&E attendances and admissions, but had no effect on QoL. | |
Schoolchildren | School-based programmes | School-based group education, the majority including education for classmates without asthma. | **Coffman 2009 [30] Children | The intervention improves knowledge, self-efficacy and self-management behaviours, but inconsistent effect on asthma control. |
16 short group educational sessions, including strategies for problem solving, delivered in the school lunch break. | Horner 2014 [53] Grades 2–5 (7–11 y) | Compared to generic health education, the intervention improved self-efficacy but had no effect on admissions, A&E visits or QoL. | ||
Peer-led programmes | Year 11 pupils were trained to deliver the school-based asthma educational lessons to younger pupils. | Al-Sheyab 2012 [48] Adolescents | Compared to children in control schools, knowledge and QoL improved. Also increased self-efficacy to resist smoking. | |
Asthma self-management skills and psychosocial skills taught at a day camp by peer leaders followed by monthly peer telephone contact. | Rhee 2011 [56] Adolescents 13–17 y | The intervention group had improved QoL and positive ‘attitude to illness’ compared to those attending adult-led camps. | ||
Technology-based | Internet-based interventions, delivered at home, clinic or school, which delivered a psycho-educational programme involving information and skills training modules targeting improved health outcomes. | **Stinson 2009 [47] Children 4–17 y | The majority of studies reported improvement in symptoms, but impact on other outcomes was inconsistent. | |
Theoretically based asthma computer programme with core modules (adherence, inhaler use, smoking reduction), with tailored sub-modules to address specific behavioural traits. | Joseph 2013 [54] 9–12 grade (14–18 y) | The intervention improved symptom control, but had no effect on A&E visits/hospitalisations. | ||
Internet-based self-management programme covering education, self-monitoring and an electronic action plan, and encouraging regular medical review. Supported by 2 face-to-face groups. | Rikkers-Mutsaerts 2012 [57] Adolescents 12–18 y | QoL and asthma control improved compared to usual care, but no difference in use of healthcare resources. | ||
Elderly | Goal-setting | Six-session programme, conducted by a health educator in groups (n = 3) and telephone calls (n = 3). Participants selected an asthma-specific goal, identified problems and addressed potential barriers. | (RCT) Baptist 2013 [49] ≥65 y | Compared to education alone, the intervention improved asthma control and QoL, but not unscheduled care. |
Addressing individual concerns | Specific concerns, identified with the Patient Assessment and Concerns Tool (PACT), were addressed in an hour-long session. Both groups had standard education (inhaler technique, PAAP). | (RCT) Goeman 2013 [51] ≥55 y | Compared to usual care, asthma control and QoL was improved by education tailored to individual patient concerns and unmet needs. |