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Table 8 Tailoring of self-management support for targeted populations

From: Systematic meta-review of supported self-management for asthma: a healthcare perspective

Group Key strategies Description of tailoring of self-management intervention Relevant systematic reviews/update RCTs Evidence
Cultural groups Cultural tailoring Culturally orientated self-management programmes including individual sessions with language-appropriate asthma educators, videos/workbooks featuring culturally appropriate role models, education appropriate to socioeconomic context, strategies for use of local healthcare services, asthma action plans. **Bailey 2009 [25]
Adults and children from minority groups
Culture-specific programmes are more effective than generic programmes in improving QoL, knowledge and asthma control but not all asthma outcomes.
Culturally tailored, community-based interventions in which healthcare providers (pharmacists, asthma educator, social workers, respiratory nurses) provided language-appropriate education programmes including health literacy-focused teaching, use of videos, asthma physiology and management, inhaler technique, PAAP. ***Press 2012 [46]
Adults from minority groups in the USA
The 5 (of 15) education studies that were culturally tailored showed reduced use of unscheduled care and improved QoL, but this is not compared to non-tailored interventions.
Internet-based programme developed to deliver education and a behaviour change intervention to African-Americans adolescents. Strategies include voice-overs to accommodate literacy limitations and advice delivered by a ‘disc jockey’. (RCT) Joseph 2013 [54]
Young teens
The intervention reduced symptom-free days but had no effect on A&E visits/hospitalisations.
Community workers Community health worker from the same/very similar community as participating families provided individually tailored education at home visits. Topics included asthma, lifestyle and trigger avoidance, with resources to reduce allergen exposure and smoking cessation support. **Postma 2009 [35]
Ethnic minority children with asthma
Interventions involving community health workers reduced emergency and urgent care use in some but not all studies.
Indigenous healthcare workers provided personalised, child-friendly, culturally appropriate education materials at home visits to reinforce clinical consultations. **Chang 2010 [29]
Ethnic minority children with asthma
The involvement of indigenous healthcare workers in asthma programmes (1 RCT) improved control and QoL but not unscheduled care.
A&E attendees Education during the A&E attendance Education sessions conducted by asthma or A&E nurses, or, less often, respiratory specialists or a physiotherapist. Content varied, usually including triggers, PAAPs and/or inhaler technique. ***Tapp 2007 [38]
Adult A&E attendees
Education delivered in A&E reduced subsequent hospital admissions but not A&E attendances. Effect on QoL was inconsistent.
PAAP, completed by the A&E physician, coupled with the prescription provided on discharge from A&E. (RCT) Ducharme 2011 [50]
Children 1–17 y, A&E attendees
Provision of a PAAP increased patient adherence to steroids (oral/inhaled), and improved asthma control.
Education after A&E Education delivered by a healthcare professional or asthma educator shortly after an A&E attendance, including triggers and PAAPs, to the child and their carers. ***Boyd 2009 [27]
Children, A&E attendees
Asthma education reduced A&E attendances and admissions, but had no effect on QoL.
Schoolchildren School-based programmes School-based group education, the majority including education for classmates without asthma. **Coffman 2009 [30]
Children
The intervention improves knowledge, self-efficacy and self-management behaviours, but inconsistent effect on asthma control.
16 short group educational sessions, including strategies for problem solving, delivered in the school lunch break. Horner 2014 [53]
Grades 2–5 (7–11 y)
Compared to generic health education, the intervention improved self-efficacy but had no effect on admissions, A&E visits or QoL.
Peer-led programmes Year 11 pupils were trained to deliver the school-based asthma educational lessons to younger pupils. Al-Sheyab 2012 [48]
Adolescents
Compared to children in control schools, knowledge and QoL improved. Also increased self-efficacy to resist smoking.
Asthma self-management skills and psychosocial skills taught at a day camp by peer leaders followed by monthly peer telephone contact. Rhee 2011 [56]
Adolescents 13–17 y
The intervention group had improved QoL and positive ‘attitude to illness’ compared to those attending adult-led camps.
Technology-based Internet-based interventions, delivered at home, clinic or school, which delivered a psycho-educational programme involving information and skills training modules targeting improved health outcomes. **Stinson 2009 [47]
Children 4–17 y
The majority of studies reported improvement in symptoms, but impact on other outcomes was inconsistent.
Theoretically based asthma computer programme with core modules (adherence, inhaler use, smoking reduction), with tailored sub-modules to address specific behavioural traits. Joseph 2013 [54]
9–12 grade (14–18 y)
The intervention improved symptom control, but had no effect on A&E visits/hospitalisations.
Internet-based self-management programme covering education, self-monitoring and an electronic action plan, and encouraging regular medical review. Supported by 2 face-to-face groups. Rikkers-Mutsaerts 2012 [57]
Adolescents 12–18 y
QoL and asthma control improved compared to usual care, but no difference in use of healthcare resources.
Elderly Goal-setting Six-session programme, conducted by a health educator in groups (n = 3) and telephone calls (n = 3). Participants selected an asthma-specific goal, identified problems and addressed potential barriers. (RCT) Baptist 2013 [49]
≥65 y
Compared to education alone, the intervention improved asthma control and QoL, but not unscheduled care.
Addressing individual concerns Specific concerns, identified with the Patient Assessment and Concerns Tool (PACT), were addressed in an hour-long session. Both groups had standard education (inhaler technique, PAAP). (RCT) Goeman 2013 [51]
≥55 y
Compared to usual care, asthma control and QoL was improved by education tailored to individual patient concerns and unmet needs.
  1. Abbreviations: A&E accident and emergency, PAAP personalised asthma action plan, QoL quality of life, RCT randomised controlled trial