Protocol for a systematic review of interventions addressing health literacy to improve asthma self-management

Hani Salim,Sazlina Shariff Ghazali,Hilary Pinnock,Ping Yein Lee,Siti Nurkamilla Ramdzan,Ingrid Young

doi:10.1038/s41533-019-0125-y

Hani Salim, Sazlina Shariff Ghazali + Show 4 more

Open Access

https://doi.org/10.1038/s41533-019-0125-y

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Abstract

Supported self-management for asthma (written action plans and regular review) is highly effective at improving control and reducing acute attacks;1–3 however, globally this is challenging to implement both in adults and children.4–7 One particular challenge is the need to tailor support for people with limited health literacy. Limited health literacy is a universal problem, especially (but not only) in low-and-middle-income countries (LMICs).8–10 For example, nearly 90% of adults with type 2 diabetes attending primary care clinics in Malaysia11 and a third of teachers in Sri Lanka12 were assessed as having limited health literacy compared to about half the general population in a European survey.9 Use of different assessment techniques and sampling of different populations make it difficult to compare these results, though it is clear that this is a problem in all countries. Derived from a systematic content analyses of 19 papers, Sorensen et al.13 describes health literacy as people’s knowledge, motivation and competence to assess, understand, appraise and apply health information (see Table Table11 for definitions). These processes are vital to enable people to make considered judgments and decisions about healthcare and health promotion, which can improve quality of life and health outcomes such as reducing morbidity.13,14 Table 1 Definition of terms

Highlights

Supported self-management for asthma is highly effective at improving control and reducing acute attacks;[1,2,3] globally this is challenging to implement both in adults and children.[4,5,6,7]
Nearly 90% of adults with type 2 diabetes attending primary care clinics in Malaysia[11] and a third of teachers in Sri Lanka[12] were assessed as having limited health literacy compared to about half the general population in a European survey.[9]
Use of different assessment techniques and sampling of different populations make it difficult to compare these results, though it is clear that this is a problem in all countries

Summary

INTRODUCTION

Supported self-management for asthma (written action plans and regular review) is highly effective at improving control and reducing acute attacks;[1,2,3] globally this is challenging to implement both in adults and children.[4,5,6,7] One particular challenge is the need to tailor support for people with limited health literacy. Derived from a systematic content analyses of 19 papers, Sorensen et al.[13] describes health literacy as people’s knowledge, motivation and competence to assess, understand, appraise and apply health information (see Table 1 for definitions) These processes are vital to enable people to make considered judgments and decisions about healthcare and health promotion, which can improve quality of life and health outcomes such as reducing morbidity.[13,14]. Schaffler et al included one asthma-related study in their review of self-management interventions among people from low socioeconomic groups (fewer than half were in populations with poor health literacy).[21] Both reviews conclude that mixed-strategy interventions targeting three to four self-management skills ( including problem-solving) are more likely to be effective than single component self-management interventions for people with limited health literacy. To inform the development of supported self-management for asthma in LMICs, we aimed to systematically search and synthesise the evidence for asthma self-management interventions targeted at people with limited health literacy, in order to assess their clinical effectiveness and to identify the behaviour change strategies that are associated with effective programmes

METHODS

MEDLINE

Salim et al 3

Findings

DISCUSSION