A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children

Abstract

BackgroundSouth Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent.MethodsData Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013.Inclusion Criteria – Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0–18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals.Data Extraction – Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion.Results15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were:1. Lack of asthma knowledge in families and healthcare professionals.2. Under-use of preventer medications.3. Non-acceptance/denial of asthma.4. Over-reliance on Emergency Department management.5. Communication problems.6. Non-adherence to medication.7. Use of complementary therapies.Little facilitators regarding asthma management were identified.ConclusionsSeveral key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs, health service utilisation pattern explanations and the impact of prejudice and stigmatisation. Other explanations such as language barriers are not strictly ethnic specific but instead reflect a minority position.Further research is required to identify why barriers exist, the mechanisms by which they impact on asthma management and how they can be overcome. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those that are related to being a minority will enable the application of generic system-wide interventions where ethnicity is not the issue and ethnically-tailored interventions where needed.

Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis

“…We hypothesized that patients with less lung disease and less treatment-related knowledge were less likely to be engaged and adherent to their prescribed medications. This is supported in the literature in case of other respiratory diseases such as asthma and chronic obstructive pulmonary disease, whereby lack of knowledge has been identified as a barrier to medication adherence and disease management 18,19. In contrast, education and knowledge has not been consistently associated with medication adherence in other chronic conditions 20,21…”

Practitioner Review: Pathways to care for ADHD – a systematic review of barriers and facilitators

“…These include asthma (Lakhanpaul et al, 2014), learning disabilities (Bhaumik et al, 2011) and diabetes (Powell, Chen, Kumar, Streisand, & Holmes, 2013). As found in this review, demographic factors, parental beliefs in the efficacy of treatments and how care is organised are important barriers to care (Lakhanpaul et al, 2014;Liptak et al, 2008;Powell et al, 2013). However, unlike many other childhood conditions, there is a wider political dimension to the existence/nonexistence of ADHD.…”

“…Although this review has focused on ADHD, individual and organisational barriers and facilitators to care have been identified for a range of paediatric conditions. These include asthma (Lakhanpaul et al., ), learning disabilities (Bhaumik et al., ) and diabetes (Powell, Chen, Kumar, Streisand, & Holmes, ). As found in this review, demographic factors, parental beliefs in the efficacy of treatments and how care is organised are important barriers to care (Lakhanpaul et al., ; Liptak et al., ; Powell et al., ).…”

Ethnic variations in asthma hospital admission, readmission and death: a retrospective, national cohort study of 4.62 million people in Scotland

“…Another potentially important explanatory consideration is differences in over-crowding with the associated risk of admissions triggered by viral upper respiratory tract infections. Differences in health professional management including access to and quality of primary care (such as vaccination rates, prescribing and use of supported self-management plans) [ 21 ] and cultural factors, including differences in personal beliefs, self-management (in particular, concordance with preventive therapies) and health-seeking behaviour, may also be important contributory factors [ 22 ]. US data have, for example, shown marked variations in the quality of ambulatory and emergency department asthma care, but comparable hospital-based care [ 23 ].…”