Developing theory‐based asthma self‐management interventions for South Asians and African Americans: A systematic review

Abstract

Purpose. Intervention development guidelines suggest that behavioural interventions benefit from being theory-based. Minority populations typically benefit less from asthma self-management interventions, and the extent to which appropriate theory has been used for culturally tailored interventions has not been addressed. We aimed to determine theory use and theoretical domains targeted in asthma self-management interventions for South Asian and Black populations.Methods. We systematically searched electronic databases, research registers, manually searched relevant journals and reference lists of reviews for randomised controlled trials of asthma self-management for South Asian and Black populations, and extracted data using the Theory Coding Scheme to inform if/how theory was used and explore its associations with asthma outcomes, and the Theoretical Domains Framework was used to identify targeted theoretical domains and its relationship to effectiveness of asthma outcomes.Results. 20 papers (19 trials) were identified; theory was not extensively used in interventions. It was unclear whether theory use or theoretical domains targeted in interventions improved asthma outcomes. South Asian interventions included 'behavioural regulation', while 'reinforcement' was mostly used in African American interventions. 'Knowledge' was central for all populations, though there were differences related to 'environmental context and resources' e.g., language adaptations for South Asians; asthma resources provided for African Americans. Author descriptions of interventions targeting providers were limited.Conclusions. There was little evidence of theory-based approaches used in cultural interventions for asthma self-management. Demystifying theoretical concepts (and cultural interpretations of constructs) may provide clarity for 'non-experts', enabling mainstream use of theory-driven approaches in intervention development.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Burden of allergic disease among ethnic minority groups in high‐income countries

“…73 Indeed, a recent systematic review found few theory-based asthma self-management interventions for South Asians and African Americans. 74 The importance of culture as a factor in health and health behaviours has been increasingly recognized, including its potential role in enhancing health messaging and interventions. The cultural characteristics of a group may have a direct or indirect relationship with health-related priorities and decision-making, as well as receptivity and adoption of health messages and interventions.…”

“…Existing theoretical models in health education have been criticized for emphasizing individual cognitive process without giving much attention to the embedment of cultural contexts and social structures in human behaviour 73 . Indeed, a recent systematic review found few theory‐based asthma self‐management interventions for South Asians and African Americans 74 …”