Salim Hani, Ramdzan Siti Nurkamilla, Ghazali Sazlina Shariff, Lee Ping Yein, Young Ingrid, McClatchey Kirstie, Pinnock Hilary
NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, United Kingdom.
Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
J Glob Health. 2020 Jun;10(1):010427. doi: 10.7189/jogh.10.010428.
Supported asthma self-management improves health outcomes. However, people with limited health literacy, especially in lower-middle-income countries (LMICs), may need tailored interventions to enable them to realise the benefits. We aimed to assess the clinical effectiveness of asthma self-management interventions targeted at people with limited health literacy and to identify strategies associated with effective programmes.
Following Cochrane methodology, we searched ten databases (January 1990 - June 2018; updated October 2019), without language restriction. We included controlled experimental studies whose interventions targeted health literacy to improve asthma self-management. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative.
We screened 4318 titles and abstracts, reviewed 52 full-texts and included five trials. One trial was conducted in a LMIC. Risk of bias was low in one trial and high in the other four studies. Clinical outcomes were reported in two trials, both at high risk of bias: one of which reported a reduction in unscheduled care (number of visits in 6-month (SD); Intervention:0.9 (1.2) vs Control:1.8 (2.4), = 0.001); the other showed no effect. None reported uptake or adherence to the intervention. Behavioural change strategies typically focused on improving an individual's psychological and physical capacity to enact behaviour (eg, targeting asthma-related knowledge or comprehension). Only two interventions also targeted motivation; none sought to improve opportunity. Less than half of the interventions used specific self-management strategies (eg, written asthma action plan) with tailoring to limited health literacy status. Different approaches (eg, video-based and pictorial action plans) were used to provide education.
The paucity of studies and diversity of the interventions to support people with limited health literacy to self-manage their asthma meant that the impact on health outcomes remains unclear. Given the proportion of the global population who have limited health literacy skills, this is a research priority.
PROSPERO CRD 42018118974.
支持性哮喘自我管理可改善健康结局。然而，健康素养有限的人群，尤其是中低收入国家（LMICs）的人群，可能需要量身定制的干预措施，以使他们能够实现这些益处。我们旨在评估针对健康素养有限人群的哮喘自我管理干预措施的临床效果，并确定与有效方案相关的策略。
按照Cochrane方法，我们检索了10个数据库（1990年1月至2018年6月；2019年10月更新），无语言限制。我们纳入了干预措施针对健康素养以改善哮喘自我管理的对照实验研究。论文筛选、数据提取和质量评估由两名审稿人独立完成。主要结局为临床结局（哮喘控制）和实施结局（干预措施的采用/依从性）。分析采用叙述性方法。
我们筛选了4318篇标题和摘要，审阅了52篇全文，并纳入了5项试验。1项试验在中低收入国家进行。1项试验的偏倚风险较低，其他4项研究的偏倚风险较高。2项试验报告了临床结局，两者的偏倚风险均较高：其中1项报告非计划护理减少（6个月内就诊次数（标准差）；干预组：0.9（1.2）对对照组：1.8（2.4），P = 0.001）；另1项未显示效果。均未报告干预措施的采用或依从情况。行为改变策略通常侧重于提高个体实施行为的心理和身体能力（例如，针对哮喘相关知识或理解）。只有2项干预措施也针对动机；没有一项旨在改善机会。不到一半的干预措施使用了特定的自我管理策略（例如，书面哮喘行动计划）并根据有限的健康素养状况进行了调整。采用了不同的方法（例如，基于视频的和图片行动计划）来提供教育。
支持健康素养有限人群自我管理哮喘的研究匮乏且干预措施多样，这意味着对健康结局的影响仍不明确。鉴于全球健康素养技能有限的人口比例，这是一个研究重点。
PROSPERO CRD 42018118974。
