Developing theory-based asthma self-management interventions for South Asians and African Americans: A systematic review.

Salina Ahmed,Elizabeth Steed,Hilary Pinnock

doi:10.1111/bjhp.12518

Salina Ahmed, Elizabeth Steed + Show 1 more

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https://doi.org/10.1111/bjhp.12518

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Abstract

Intervention development guidelines suggest that behavioural interventions benefit from being theory-based. Minority populations typically benefit less from asthma self-management interventions, and the extent to which appropriate theory has been used for culturally tailored interventions has not been addressed. We aimed to determine theory use and theoretical domains targeted in asthma self-management interventions for South Asian and Black populations. We systematically searched electronic databases, research registers, manually searched relevant journals and reference lists of reviews for randomised controlled trials of asthma self-management for South Asian and Black populations, and extracted data using the Theory Coding Schemeto inform if/how theory was used and explore its associations with asthma outcomes, and the Theoretical Domains Framework was used to identify targeted theoretical domains and its relationship to effectiveness of asthma outcomes. 20 papers (19 trials) were identified; theory was not extensively used in interventions. It was unclear whether theory use or theoretical domains targeted in interventions improved asthma outcomes. South Asian interventions included 'behavioural regulation', while 'reinforcement' was mostly used in African American interventions. 'Knowledge' was central for all populations, though there were differences related to 'environmental context and resources' e.g., language adaptations for South Asians; asthma resources provided for African Americans. Author descriptions of interventions targeting providers were limited. There was little evidence of theory-based approaches used in cultural interventions for asthma self-management. Demystifying theoretical concepts (and cultural interpretations of constructs) may provide clarity for 'non-experts', enabling mainstream use of theory-driven approaches in intervention development.

Highlights

Asthma is a chronic respiratory illness caused by airway inflammation, which presents with variable symptoms including wheeze, chest tightness, and cough (GINA, 2016; NRAD, 2014; SIGN, 2016)
Four interventions with South Asian participants were from India (Agrawal et al, 2005; Behera eta al., 2006; Ghosh et al, 1998; Shanmugam et al, 2012), three interventions with South Asian participants were from the UK and one was from Canada (Griffiths et al, 2004, 2016; Moudgil, Marshall, & Honeybourne, 2000; Poureslami et al, 2012), and twelve interventions with African American participants were from the USA (Bignall et al, 2015; Blixen et al, 2001; Fisher et al, 2009; Fisher et al, 2004; Ford et al, 1997; Kelso et al,1995, 1996; MacDonell et al, 2016; Patel et al, 2017; Velsor-Friedrich et al, 2012; Velsor-Friedrich, Pigott, & Louloudes, 2004; Velsor-Friedrich, Pigott, & Srof, 2005)
This review included 20 papers (19 randomised controlled trials (RCTs)) evaluating asthma self-management interventions targeted at South Asians and African Americans

Summary

Introduction

Asthma is a chronic respiratory illness caused by airway inflammation, which presents with variable symptoms including wheeze, chest tightness, and cough (GINA, 2016; NRAD, 2014; SIGN, 2016). There are concerns that ethnic minority groups tend to benefit less from these strategies incorporated in interventions compared to White populations (Ahmed et al, 2018; Davidson, Liu, & Sheikh, 2010; Netuveli et al, 2005). Understanding what underlies this is important to reduce health inequalities (Ahmed et al, 2018). Cultural tailoring of interventions for ethnic minority groups has been suggested to be beneficial (Ahmed et al, 2018; Barrera et al, 2013)

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