Task-shifting to improve asthma education for Malawian children: a qualitative analysis

Lovemore Nkhalamba,Kevin Mortimer,Adamson S Muula,Felix Limbani,Sarah Rylance

doi:10.1186/s12960-021-00576-1

Abstract

BackgroundAsthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.MethodsWe conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.ResultsPrior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.DiscussionAsthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.Trial registration The RCT was registered in the Pan African Clinical Trials Registry: PACTR201807211617031

Highlights

Asthma is a growing public health burden in low- and middle-income countries (LMICs); worldwide, approximately 1000 people die every day, with the majority of deaths occurring in LMICs [1]
Some parents and children expressed their concerns about hostile attitudes they had encountered from some medical staff previously, which affected their willingness to ask for clarification when needed
We collated the dimensions of our intervention and the context in which it was delivered in to show the key components of an ideal task-shifting intervention for asthma education by lay educators (Fig. 1). To our knowledge this is the first evaluation of an asthma education task-shifting intervention in Sub-Saharan Africa (SSA), in which asthma education is delivered by educators with no medical or nursing background

Summary

Introduction

Asthma is a growing public health burden in low- and middle-income countries (LMICs); worldwide, approximately 1000 people die every day, with the majority of deaths occurring in LMICs [1]. Successful asthma care requires that both children and parents receive adequate information on asthma, triggers, medication and selfmanagement of symptoms. A key component of long-term asthma management, is challenging in resourcelimited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention

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Methods

Results

Discussion

Conclusion