Asthma UK Centre for Applied Research, Blizard Institue Queen Mary University London, London, UK.
Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
NPJ Prim Care Respir Med. 2018 Feb 15;28(1):5. doi: 10.1038/s41533-017-0070-6.
South Asian and other minority communities suffer poorer asthma outcomes, have a higher rate of unscheduled care and benefit less from most existing self-management interventions when compared to the majority population. Possible reasons for these differences include failure to implement asthma self-management strategies, or that strategies implemented were inappropriate for their needs; alternatively, they may relate to the minority and/or lower socioeconomic status of these populations. We aimed to synthesise evidence from randomised controlled trials for asthma self-management in South Asian and Black populations from different sociocultural contexts, and identify barriers and facilitators to implementing self-management. We systematically searched eight electronic databases, and research registers, and manually searched relevant journals and reference lists of reviews. Seventeen trials met the inclusion criteria and were analysed narratively. We found two culturally targeted interventions compared to fifteen culturally modified interventions. Interventions used diverse self-management strategies; education formed a central component. Interventions in South Asian and African-American minority communities were less effective than interventions delivered in indigenous populations in South Asia, though the latter trials were at higher risk of bias. Education, with continuous professional support, was common to most interventions. Facilitators to asthma self-management included: ensuring culturally/linguistically appropriate education, adapting to learning styles, addressing daily stressors/social support and generic self-management strategies. In conclusion, when developing and evaluating self-management interventions aimed at different cultures, the influence of sociocultural contexts (including whether patients are from a minority or indigenous population) can be important for the conceptualisation of culture and customisation of self-management strategies.
南亚和其他少数族裔群体的哮喘治疗效果较差，非计划性护理的比例较高，并且从大多数现有的自我管理干预措施中获益较少，而与多数人群相比。造成这些差异的可能原因包括未能实施哮喘自我管理策略，或者实施的策略不适合他们的需求；或者，这些差异可能与这些人群的少数族裔和/或较低的社会经济地位有关。我们旨在综合来自不同社会文化背景的南亚和黑人人群中哮喘自我管理的随机对照试验证据，并确定实施自我管理的障碍和促进因素。我们系统地搜索了八个电子数据库和研究登记处，并手动搜索了相关期刊和评论的参考文献。有 17 项试验符合纳入标准，并进行了叙述性分析。我们发现了两项针对特定文化的干预措施，而不是十五项针对文化的修改干预措施。干预措施使用了不同的自我管理策略；教育是一个核心组成部分。南亚和非裔美国少数民族社区的干预措施不如南亚本土人群的干预措施有效，尽管后者的试验存在更高的偏倚风险。教育，加上持续的专业支持，是大多数干预措施的共同点。哮喘自我管理的促进因素包括：确保文化/语言上的适当教育，适应学习方式，解决日常压力源/社会支持和通用自我管理策略。总之，在为不同文化开发和评估自我管理干预措施时，社会文化背景的影响（包括患者是否来自少数民族或本土人群）对于文化的概念化和自我管理策略的定制非常重要。
