Title: Barriers to effective self-management of asthma: A systematic review
Funder: Asthma UK

Abstract: The purpose of this review is to identify which groups of people are at risk of poor asthma self-management and to explore why self-management approaches are not more widely used. This review will therefore provide an important evidence-base for informing how interventions to encourage self-management are designed and delivered. Rationale British guidelines on the management of asthma recommend that people with asthma should self-manage their condition. The most successful approaches to self-management combine education about asthma with self-monitoring of symptoms or peak flow, the use of a written personal action plan, and regular medical review. The use of these approaches can improve quality of life, symptoms and peak flow, and reduce the number of visits to hospital and the use of reliever medication. Although self-management has such benefits, not many people with asthma use these approaches. Evidence suggests that this may be for a variety of reasons. Health professionals may not suggest them to their patients in the first place. When self-management is suggested, some people may not be able to or want to try the approaches. Other people may try them, but not be able to or want to continue their use. Because self-management approaches are so beneficial for people who are able to and want to use them, it is important to find out the reasons why so many people with asthma do not use them. This information can then be used to suggest changes to the way self-management and support are currently provided. This would result in better services being provided and more people being able to access or continue to experience the benefits of self-management. We propose to investigate four categories of reasons why interventions to improve self-management are not more widely used. Category 1: reasons relating to particular groups of people with asthma. There is growing evidence that some particular groups of people with asthma are less likely to successfully self-manage their condition. It has also been suggested that existing standard interventions to teach self-management approaches may not be so helpful for these groups. Examples of such groups include people from ethnic minorities, people with a low income and teenagers. One of the aims of this review is to get a better understanding of who these groups are, and why they are not helped as much by existing intervention programmes. New interventions could then be specifically targeted to help these groups. If any existing interventions are helpful, we will try to identify what the helpful features of these interventions are so that they can be replicated. Category 2: reasons relating to the beliefs, skills and behaviours of people with asthma Some people may not successfully self-manage their condition because of particular beliefs about asthma or treatment, which may lead to particular behaviours. For example some people with asthma may believe that they do not have the skills to successfully self-manage their condition so do not feel confident enough to carry out the self-management techniques. This review will aim to identify relevant beliefs, skills and behaviours that are associated with poor self-management. Such reasons could then be targeted within an intervention to support and enable people to successfully self-manage their condition. Category 3: reasons relating to the beliefs of health professionals Evidence exists that suggests that some health professionals do not discuss or encourage the use of self-management approaches. This may be the result of beliefs about self-management or beliefs about their patients’ ability to carry out self-management. This review aims to identify and summarise what has been studied in relation to the beliefs and behaviours of health professionals. For example, it would be useful to identify the extent to which these beliefs are held and if any evidence exists to support these beliefs. It would also


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: RESPIRATORY