Table 1.

Table of included studies

Study (country)	Study type	Population	Barriers	Facilitators	Critique
Kuehni3 (UK)	Prevalence survey	6080 children aged 1-4	Possible under-treatment with steroids	NS	High response rate
Hazir15 (Pakistan)	Questionnaire based interview	200 parents/carers of children with asthma aged 2–13; attended hospital asthma clinic between 3 m-7 y	Lack of understanding of medication use, food beliefs, social stigma & poor child self-esteem	Lack of awareness not significantly related to socioeconomic or educational background. Community strategies to raise awareness needed.	Pakistan is an ethically, culturally & socially diverse country. Hospital based study therefore may not reflect true situation in community.
Shivbalan16 (India)	Questionnaire survey	100 children aged 2–15 with total >4 wheeze episodes, 2 wheeze episodes in the last 6 months with at least 2 ED visits and 1 hospitalisation.	Lack of knowledge and acceptance about asthma, poor understanding of aetiology & prognosis, misconceptions about long-term medications, social stigma & reliance on GPs for information	Awareness of triggers	No clear details on ethical approval or eligible/recruited numbers. Majority of participants from same socioeconomic status therefore may not be representative
Haque17 (Pakistan)	Questionnaire survey pre/post seminar	82 GPs registered with the College of Family Medicine	Lack of knowledge by healthcare professionals	NS	Participants were GPs who voluntarily attended an educational programme & therefore results may be biased towards motivated GPs
Gautam18 (India)	Questionnaire survey	157 GPs registered with the Delhi Medical Association	Knowledge gaps in different GPs. Includes diagnosis, misconceptions about food and exercise avoidance and parental smoking effects	NS	No clear inclusion/exclusion criteria & mention questionnaire validity. Non-respondent bias may be present–43 (21.5%) GPs refused.
Lai19 (India)	Questionnaire survey	85 children with asthma ages 6–17 with minimum 2 years since symptom onset.	Poor physician-parent communication, social stigma, misconceptions about food avoidance & beliefs that modern medicines cause harm	Parents keen to learn & parental recognition of importance of treating asthma	No clear recruitment methodology & mention of questionnaire validity. Participants enrolled in asthma clinic so biased towards those receiving medical care.
Ormerod20 (UK)	Prevalence survey	1783 adults and children with asthma aged 0–70 registered with participating GP practice	Asthma under-diagnosis with possible under-recognition & reporting	NS	No clear recruitment methodology and no sample size calculations. Findings reflect Blackburn GPs so may not be generalisable.
Duran-Tauleria21 (UK)	Questionnaire survey	14490 children aged 5–11 with respiratory symptoms including asthma, wheeze & bronchitis66	NS	Ethnic monitoring and targets for specific populations to monitor adherence to clinical guidelines & indicators to monitor inequalities in asthma treatment in minority ethnic communities	No clear sampling & recruitment methodology & no clear inclusion/exclusion criteria.
Cane22 (UK)	Focus groups	66 mothers aged 22–45 from Bangladeshi, White or Black Caribbean backgrounds.	Different (sometimes inaccurate) understandings of asthma, use of alternative medications, delay in seeking Western medical help & stigma	NS	Study based on mothers’ perception of video of child with an asthma attack with lack of further content. Unclear analysis methodology. No data on socioeconomic or educational background collected.
Smeeton23 (UK)	Questionnaire survey	150 parents of children with asthma aged 3-9	Stigma, erroneous beliefs & choosing not to give medications	NS	Clear recruitment and sampling methodology with clear analysis. High proportion of SA participants born outside UK with low education level & therefore may impact results.
Singh24 (India)	Questionnaire survey	1012 adults and children with asthma	Lack of knowledge about asthma, failure of recognising warning symptoms, beliefs in permanent cure, use of complementary medicine & treatment non-adherence	Children preferred inhalers whereas adults preferred oral medications	No data on questionnaire validity. No clear eligibility, inclusion & exclusion criteria. Use of numerous closed questions. Study and analysis included both adults and children.
Mittal25 (India)	Questionnaire survey	52 child–parent pairs; children aged 6–15 diagnosed with asthma	Parent and child ability to perceive symptom severity (influenced by child’s age), cigarette smoke exposure and asthma severity	NS	Unclear reason of chosen sampling and recruitment method.
Michel26 (UK)	Questionnaire survey	4236 children aged 6-10	English as second language & deprivation	Higher maternal education.	Parents received three study questionnaires so may have had a learning effect. Low response rates of 52% of Whites & 40% of South Asians.
Panico27 (UK)	Cohort study	14630 singleton infants aged 3 whose mothers participated in the survey	Language & maternal migration – suggests the lack of UK familiarity & language skills leads to underreporting of asthma	NS	Despite large study size small SA group samples (5%). Barriers are inferred. Children of mixed ethnicity classified according to the EM parent’s group and may lead to effect attenuation.
Carey28 (UK)	Prevalence survey	847 children aged 8–11 with asthma, atopy or bronchial hyperreactivity	Western diet associated with more hyperreactivity	Asian diet appears protective	No data on questionnaire reliability and validity.

NS = none specified.