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

Ping Yein Lee,Hani Salim,Ahmad Ihsan Abu Bakar,Yong Kek Pang,Sazlina Shariff Ghazali,Ee Ming Khoo,Ai Theng Cheong,Su May Liew,Hilary Pinnock,Azainorsuzila Mohd Ahad,Norita Hussein,Nik Sherina Hanafi,Karuthan Chinna,Rizawati Ramli,Jasmine Wong

doi:10.1038/s41533-021-00250-y

Abstract

Asthma self-management is a crucial component of asthma management. We sought to explore healthcare professionals’ (HCPs’) perceptions on barriers to asthma self-management implementation in primary care. We recruited 26 HCPs from six public primary care clinics in a semi-urban district of Malaysia in 2019. The analysis was done inductively. HCPs described barriers that resonated with the “COM-B” behaviour change framework. Capability-related issues stemmed from a need for specific self-management skills training. Opportunity-related barriers included the need to balance competing tasks and limited, poorly tailored resources. Motivation-related barriers included lack of awareness about self-management benefits, which was not prioritised in consultations with perceived lack of receptiveness from patients. These were compounded by contextual barriers of the healthcare organisation and multilingual society. The approach to implementation of asthma self-management needs to be comprehensive, addressing systemic, professional, and patient barriers and tailored to the local language, health literacy, and societal context.

Highlights

Supported self-management is a crucial component of long-term asthma management[1,2] in adults that improves clinical outcomes and reduces healthcare costs[3]
We aimed to explore healthcare professionals’ (HCPs’) views of the barriers faced in implementing supported self-management for asthma in adults in a primary care setting in Malaysia, taking into consideration the country’s cultural and socioeconomical contexts
This study identifies some significant challenges in the implementation of supported asthma self-management in primary care practice in Malaysia

Summary

INTRODUCTION

Supported self-management is a crucial component of long-term asthma management[1,2] in adults that improves clinical outcomes and reduces healthcare costs[3]. A wide range of barriers to implementing supported selfmanagement were described in a recent systematic review— these include, poor patient–professional partnership, lack of patient education and concerns regarding medication safety, insufficient professional training, and negative views regarding asthma self-management, compounded by competing priorities and limited time in consultations[13]. Underpinning many of these barriers are challenges to effective communication[13,14]. We aimed to explore healthcare professionals’ (HCPs’) views of the barriers faced in implementing supported self-management for asthma in adults in a primary care setting in Malaysia, taking into consideration the country’s cultural and socioeconomical contexts

Participants

DISCUSSION

METHODS