Academic Unit of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
Department of Psychology, Bournemouth University, Poole, UK.
NPJ Prim Care Respir Med. 2017 Oct 9;27(1):57. doi: 10.1038/s41533-017-0056-4.
Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: (1) partnership between patient and health care professional; (2) issues around medication; (3) education about asthma and its management; (4) health beliefs; (5) self-management interventions; (6) co-morbidities (7) mood disorders and anxiety; (8) social support; (9) non-pharmacological methods; (10) access to healthcare; (11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma.
自我管理是一种既定的、有效的控制哮喘的方法，在指南中得到推荐。然而，患者和医疗保健专业人员对其的推广、采用和使用仍然很低。已经报道了许多影响有效自我管理的障碍和促进因素，并且在定性研究中探讨了患者和医疗保健专业人员的观点和信念。我们对有关哮喘自我管理的患者、护理人员和医疗保健专业人员的自我管理的定性研究进行了系统综述和主题综合分析，以确定与哮喘自我管理干预措施有效性降低相关的感知障碍和促进因素。系统地搜索电子数据库和指南，以寻找探索与哮喘患者自我管理的采用、依从性或结果相关的促进因素和障碍的定性文献。对纳入的 56 项研究进行主题综合分析，确定了 11 个主题：（1）患者和医疗保健专业人员之间的伙伴关系；（2）药物问题；（3）哮喘及其管理教育；（4）健康信念；（5）自我管理干预措施；（6）合并症；（7）情绪障碍和焦虑；（8）社会支持；（9）非药物治疗方法；（10）获得医疗保健；（11）专业因素。由此，在哮喘患者（和护理人员）以及医疗保健专业人员层面确定了感知障碍和促进因素。未来的工作需要解决成人、青少年和儿童（和护理人员）对哮喘的担忧和信念、有效沟通和伙伴关系、量身定制的支持和教育（包括少数民族和高危人群）以及远程医疗等问题，可能会改善专业人员推荐和患者使用自我管理的方式。最终，这可能会改善哮喘患者的预后。
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