Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS)

Abstract

BackgroundPeople with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK.MethodsA cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care.Findings375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively.ConclusionsA multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma.

Synthesis of researcher reported strategies to recruit adults of ethnic minorities to clinical trials in the United Kingdom: A systematic review

“…(42,43). Of the remaining one trial each was on multimorbid conditions (44) postnatal support (45) kidney disease (46) and asthma (47).…”

“…With regards to translation and adaptation of outcome, 3 trials translated, adapted and explained the overall process of adaptation (27,29,47). In addition, 5 trials used existing translated and adapted outcome measure from another source (28,35,37,41,44).…”

“…Five trials reported the use of day centres for recruitment as these centres exclusively catered to a high number of ethnic minority participants (27,29,31,42,47) 3.1.3 Self referrals and assistance from family and carers Two trials referred to recruiting family members from participants already recruited (32,36).…”

IMP2ART systematic review of education for healthcare professionals implementing supported self-management for asthma

“…Characteristics of the included studies are summarised in Table 1 . Studies were published between 1993 and 2016 and took place across seven countries: USA (6), 16 – 21 , 24 , 26 , 29 Australia (2), 28 , 31 Israel (2), 23 , 33 UK (2), 22 , 25 the Netherlands (1), 30 Singapore (1), 27 and Sweden (1). 32 Eight were cluster RCTs, 17 – 19 , 22 , 24 – 26 , 29 , 30 three were RCTs, 16 , 20 , 21 , 27 , 28 and four were CCTs.…”

Protocolled practice nurse-led care for children with asthma in primary care: protocol for a cluster randomised trial

“…The aim of the current pragmatic trial is to compare protocolled nurse-led care by the practice nurse to the usual care of the GP. Cluster randomised trial designs are common in pragmatic research 44–46. Cluster randomised trials have particular utility in effectiveness and implementation studies.…”