Generational perspective on asthma self-management in the Bangladeshi and Pakistani community in the United Kingdom: A qualitative study

Co-Designing Strategies to Improve Asthma Health Literacy With Culturally and Linguistically Diverse Communities

BACKGROUND

Evidence indicates that an early intervention nurse-led model of care transitioning consumers with asthma from hospital to home improves asthma health literacy and asthma control compared with usual care. This intervention, however, is not reaching individuals from Culturally and Linguistically Diverse (CALD) communities who require added support to navigate our health care system.

AIMS

To (1) investigate the barriers and enablers to improving asthma care in consumers from three CALD communities and (2) improve the nurse-led programme to suit the needs of CALD consumers with asthma.

METHODS

Participants with asthma from Vietnamese, Indian and Sri Lankan communities and clinicians providing asthma care completed separate and combined focus group workshops. Qualitative data were collected on the barriers and enablers for asthma health literacy, attendance at clinics and Emergency Department presentations. Input was sought on to how to adapt the nurse-led programme to support CALD consumers. Data was thematically analysed and discussed in the combined clinician and consumer session with a view to integrating the key findings into the current care model.

RESULTS

Nine consumers with asthma and nine clinicians were recruited. Key findings included language and communication barriers (despite interpreters), poor understanding of asthma, poor cultural support (other than interpreters), poor trust in the hospital system, lack of access to and affordability of general practice, specialist clinics and hospitals.

CONCLUSION

The findings informed the modification of our model of care to include bicultural health educators, who support consumers' transition from hospital to home. This model of care is currently under evaluation. SO WHAT?: Nurse-led models of asthma care improve asthma control and health literacy but are not reaching individuals from CALD communities. We asked participants with asthma from three CALD communities, and clinicians looking after those with asthma to provide insights on the barriers (challenges) and enablers (solutions) to improving asthma outcomes and the health care journey for CALD consumers.

Exploring Experiences and Asthma Management Among Middle Eastern Arabic-Speaking Migrants and Refugees with Asthma: A Qualitative Study

Purpose

Effective asthma management relies on individuals' knowledge, inhaler technique, and perceptions of asthma and medications. Investigating barriers and enablers to optimal asthma management is vital. This research pursues a comprehensive understanding of asthma control, asthma-related experiences, perceptions, inhaler technique, and knowledge among Arabic-speaking Middle Eastern migrants and refugees living in Australia. Furthermore, it aims to explore the factors influencing optimal asthma management within this demographic.

Patients and Methods

This study involved interviews with 17 participants, with nine identified as migrants and eight as refugees. All participants were Arabic-speaking Middle Eastern individuals residing in Australia and diagnosed with asthma. Interviews were thematically analysed, and findings were presented following the guidelines of the consolidated criteria for reporting qualitative research (COREQ).

Results

The thematic analysis yielded five key themes: (1) asthma experiences; (2) participant perspectives on asthma; (3) asthma management; (4) asthma health literacy; and (5) strategies to overcome obstacles in asthma management. Some disparities were noted between refugees and migrants in terms of their comprehension and views on asthma, medications use, interactions with healthcare providers, and inhaler technique. Refugees experienced more psychological distress and lacked social support, while migrants were more concerned about long-term medication use and preferred specialised care.

Conclusion

This research addresses a knowledge gap concerning asthma control among Middle Eastern immigrants. It provides insights into their beliefs and medication adherence. It underscores the importance of considering the unique characteristics of Middle Eastern migrants and refugees when delivering healthcare interventions to enhance overall health and medication adherence within these populations. To address these differences, the study recommends tailored education, specialised clinics, and culturally relevant asthma management plans to enhance self-management support for both groups. Future studies should explore the impact of modifying beliefs, attitudes, and knowledge regarding medications and asthma to enhance asthma management within this population.

Exploring the perspectives of healthcare professionals on providing supported asthma self-management for Bangladeshi and Pakistani people in the UK

BACKGROUND

Self-management support improves asthma outcomes and is widely recommended in guidelines, yet it is poorly implemented in routine practice. There may be additional challenges in the context of ethnic minority groups, where making sense of culture may be necessary. This study aimed to explore the perspectives of healthcare professionals on supporting UK Bangladeshi and Pakistani patients to self-manage their asthma.

METHODS

One-to-one semi-structured interviews with professionals (primary and secondary care; medical and nursing) who routinely provide asthma care to Bangladeshi or Pakistani patients. Topics addressed included perceptions of professionals in supporting patients with asthma self-management and ideas for improving culturally competent care. Data were analysed thematically.

RESULTS

Nine professionals, from a range of ethnic backgrounds, with considerable experience of treating patients from these communities were interviewed. Despite organisational restrictions (language and time/resources) and expressed gaps in cultural knowledge and training, all interviewees reported attempting to tailor support according to culture. They used their perception of the patient's culture (e.g., big families and family involvement), integrated with their perception of patients' ability to self-manage (e.g., degree of responsibility taken for asthma), to formulate theories about how to culturally adapt their approach to supported self-management, e.g., supporting barriers in understanding asthma. There was consensus that gaps in cultural knowledge of professionals needed to be addressed through training or information. Interventions recommended for patients included basic education, group meetings, and culturally relevant action plans.

CONCLUSION

In the absence of formal training and constrained by organisational limitations, self-management support was adapted based on personal and professional perception of culture. These ideas were based on experience and formulated a chain of reasoning. Professionals recognised the limitations of this approach and potential to overgeneralise their perceptions of culture and adaptations of supported self-management. Interventions were desired and need to address professional training in cultural competence and the provision of culturally relevant materials.

Experience in Accessing Healthcare in Ethnic Minority Patients with Chronic Respiratory Diseases: A Qualitative Meta-Synthesis

BACKGROUND

Access to healthcare is part of every individual's human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why healthcare disparities occur with patients from a minority background has the potential to improve health equality and care quality. This qualitative systematic review aims to gain insights into the experiences of people with chronic respiratory diseases (CRDs) from a minority background and explore factors contributing to their experiences in accessing healthcare to inform related health policy makers and healthcare providers.

METHODS

This systematic review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, where the Joanna Briggs Institute meta-aggregative instrument facilitated the qualitative synthesis. The study protocol was registered with PROSPERO (CRD42022346055). PubMed, Scopus, Web of Science, and CINAHL were the databases explored.

RESULTS

From the papers selected, 47 findings were derived from 10 included studies, and four synthesised findings were generated: (1) the relationship between patients and healthcare professionals affects the usage of healthcare services; (2) patients' perceptions and cultural beliefs affect their compliance with disease management; (3) personal behaviours affect the usage of healthcare services; and (4) health resource inequalities have an impact on accessing healthcare services.

CONCLUSIONS

This systematic review demonstrates that ethnic minorities with CRDs face inequalities when engaging in healthcare. The relationship between patients and clinicians impacting the use of healthcare is the most pivotal discovery, where not speaking the same language and being of a different race alongside the accompanying criticism and faith in facilities are key contributors to this effect. In addition, the thinking patterns of these marginalised groups may reflect their cultural upbringing and diminish their engagement with therapies. This paper has uncovered ways to attenuate inequalities amongst ethnic minorities in engaging with healthcare providers and provides insight into building effective equity-promoting interventions in healthcare systems. To overcome these disparities, coaching doctors to communicate better with minority cohorts could help such patients to be more comfortable in connecting with medical facilities.

Personalised management and supporting individuals to live with their asthma in a primary care setting

INTRODUCTION

Complementing recognition of biomedical phenotypes, a primary care approach to asthma care recognizes diversity of disease, health beliefs, and lifestyle at a population and individual level.

AREAS COVERED

We review six aspects of personalized care particularly pertinent to primary care management of asthma: personalizing support for individuals living with asthma; targeting asthma care within populations; managing phenotypes of wheezy pre-school children; personalizing management to the individual; meeting individual preferences for provision of asthma care; optimizing digital approaches to enhance personalized care.

EXPERT OPINION

In a primary care setting, personalized management and supporting individuals to live with asthma extend beyond the contemporary concepts of biological phenotypes and pharmacological 'treatable traits' to encompass evidence-based tailored support for self-management, and delivery of patient-centered care including motivational interviewing. It extends to how we organize clinical practiceand the choices provided in mode of consultation. Diagnostic uncertainty due to recognition of phenotypes of pre-school wheeze remains a challenge for primary care. Digital health can support personalized management, but there are concerns about increasing inequities. This broad approach reflects the traditionally holistic ethos of primary care ('knowing their patients and understanding their communities'), but the core concepts resonate with all healthcare.

Assessing the Impact of Health Education Intervention on Asthma Knowledge, Attitudes, and Practices: A Cross-Sectional Study in Erbil, Iraq

Asthma causes chronic coughing, wheezing, dyspnea, and chest pressure. This study assessed asthmatic patients' knowledge, attitudes, and practice (KAP) of bronchial asthma and proper education on its meaning, risk factors, symptoms, diagnosis, management, and prevention practices. We performed a cross-sectional interventional asthma KAP survey in Erbil, Iraq. We adapted a validated study questionnaire from KAP studies in other nations to the Erbil situation and culture. In Erbil, Kurdistan, Iraq, two major hospitals' asthma clinics were studied. We chose 250 asthmatic patients from October 2018 to July 2019. Health education was comprehensive. The health education program used a Kurdish PowerPoint with a printout. Twenty-five groups received two weeks of one-hour health education pre-intervention. Each group was questioned before, 2 weeks after, and 12 weeks after health education. All data were analyzed by SPSS v26. The mean age of the respondents was 37.52 ± 15.16, with 48.7% of the respondents having a positive family history of asthma. After 2 weeks of health education intervention, respondents had a higher knowledge score and positive attitudes compared to pre-education, and after 12 weeks of education, there was a significant difference (p < 0.001) with improvised prevention practice. Health education programs led to considerable improvements in asthmatic patients' knowledge, attitudes, and practices regarding their condition. After receiving health education for a period of two weeks, the majority of the participants answered correctly regarding asthma, its causes, and the elements that trigger asthma attacks.