Explanatory factors enhancing the adoption of asthma self-management behaviour in South Asian and Black populations: A systematic review

Abstract

Background: UK South Asians have unique asthma experiences including poorer asthma outcomes and a higher hospitalisation and death rate compared to the White population. One explanation for this may be that self-management strategies have been inadequate for their needs or have not been instigated in the first place. Aim: To detect barriers and facilitators of applying self-management strategies in South Asian and Black individuals, and identify key components for culturally tailored asthma interventions. Method: 8 databases, 3 research registers, 3 journals and reference lists of systematic reviews were reviewed for asthma self-management randomised control trials in South Asian and Black individuals. Measured outcomes were clinical (e.g. health service use), process (e.g. self-efficacy) and behavioural (e.g. adherence). Result: Narrative analysis included 17 studies (8 South Asian, 9 Black). We found one culturally tailored intervention compared to 16 culturally modified interventions. Several barriers and facilitators were identified such as those common across all ethnicity and social contexts e.g. education. Outcome analysis of South Asian trials show significant impact on some outcomes e.g. knowledge, and mixed findings for others e.g. unscheduled care. Conclusion: Early analysis indicates variable impact on outcomes. Evidence is limited around culturally tailored compared to culturally modified interventions. Education is central to self-management interventions across all groups but understanding is not always addressed and minority population facilitators indicate supported self-management is crucial in Western countries.