Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

Lee, Ping Yein; Cheong, Ai Theng; Ghazali, Sazlina Shariff; Salim, Hani; Wong, Jasmine; Hussein, Norita; Ramli, Rizawati; Pinnock, Hilary; Liew, Su May; Hanafi, Nik Sherina; Bakar, Ahmad Ihsan Abu; Ahad, Azainorsuzila Mohd; Pang, Yong Kek; Chinna, Karuthan; Khoo, Ee Ming

doi:10.1038/s41533-021-00250-y

Cited by 12 publications

(12 citation statements)

References 56 publications

(74 reference statements)

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“…Participants highlighted some important gaps in asthma care by primary care doctors in public health clinics including inadequate assessment of control, little treatment intensification for poorly controlled patients and no provision of asthma education. This corresponds with findings from the recent literature which underscored the challenges contributing to these three gaps 14,15 .…”

Section: Discussionsupporting

confidence: 90%

Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Ramli

Hanafi

Hussein

et al. 2023

Asia Pac J Public Health

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Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians’ level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim’s health literacy and facilitated by educational resources, family engagement, and regular health briefing.

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Section: Discussionsupporting

confidence: 90%

Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Ramli

Hanafi

Hussein

et al. 2023

Asia Pac J Public Health

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“…We found some of these, including asthma action plans, were not available in important clinic areas such as the emergency rooms, consultation rooms, and pharmacies. A previous local qualitative study found the main reasons for this were budget constraints and lack of prioritisation 20 . Another local study documented adequate numbers of peak flow metres and PEFR reference charts provided in the clinic, however, there was no spacer or placebo inhalers available for teaching patients 21 .…”

Section: Discussionmentioning

confidence: 98%

Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia

Hussein

Ramli

Liew

et al. 2023

npj Prim. Care Respir. Med.

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Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.

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“…There was also a poor attitude reported in the patients' respondents in which majority felt that they were for very sick patients; Majority of the patients indicated that the use of PAAPs should be used for the very sick people. The practice was poor even for those few who had these tools; in which from a sample of 52 patients who were found to have a PAAPs card those who used to check for their card at home while low count among the respondents who didn't check their card [21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitude and Practices on the Use of Asthma Action Plans among Adult Asthmatic Patients Aged 18-65 in Nyamira, Kenya

Obara

Muhonja

Simba

et al. 2023

IJTDH

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Introduction: Globally the World Health Organization (WHO) estimates that up to 334 million people suffer from asthma. In Kenya it is estimated that about 10% of the Kenyan population, or 4 million people, have asthma. Aim: The objective of this study was to assess knowledge, attitude and practices of patients 18-65 on the use of personized asthma action plans in Nyamira County. Methodology: Cross-sectional study design was employed in this research. Participants were selected using systematic sampling. Significant differences in categorical variables were found using the Chi-square and Fisher's Exact Test. The threshold for statistical significance was set at p<0.05. Results: The study sample size was 220 asthma patients. The majority of responders 72.7% were unaware of PAAPs. Concerning attitude, most of participants had a negative attitude about the use of PAAPs, believing that they should only be used by the extremely ill 63.6%. Poor practices were seen among the patients who had access to these tools, with 39.0% checking them at home and 61.0% never checking them at all. Statistically there were significant association between the various patients’ factors influencing use of asthma action plans among adult asthmatic patients with a p = 0. 021. Conclusion: The majority of the patients 76.4% who participated in this research did not use the personalized asthma action plan cards. Additionally, the majority of participants reported poor practices on PAAPs, low levels of awareness, and negative attitudes. To combat the low-level knowledge, negative attitude, and poor practices among asthma patients, the ministry of health should raise awareness about the use of PAAPs.

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Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

Cited by 12 publications

References 56 publications

Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia

Knowledge, Attitude and Practices on the Use of Asthma Action Plans among Adult Asthmatic Patients Aged 18-65 in Nyamira, Kenya

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