Table 5.
Self-management interventions
| Sub-theme | Summary findingsa,b |
|---|---|
| Positive feelings over action plan or guideline use from patients and HCPs | • Some patients have positive attitudes to action plans55,62 and guidelines46 (P), and felt that regular reviews could facilitate their control and empower them to self-manage their condition54 (P). Some caregivers of urban African American teenagers instigated the development of an asthma action plan with their school nurse34 (Ca). Some adolescent patients also saw Internet action plans as useful71 (P/Ch). |
| • Patients who do not have a plan report feeling it would be useful45,55,62 and some would like to try peak flow readings alongside their action plans55 (P). | |
| • Some GPs report that guidelines are useful for managing asthma, particularly for those with difficult/severe asthma and in deciding medication steps46 (HCP). | |
| • School nurses and staff wanted an action plan for all children with asthma, but did not receive one in most cases31 (S). Many HCPs plan ahead if they are expecting a child who will need school documentation including an asthma action plan39 (HCP). | |
| Negative feelings over action plan or guideline use from patients and HCPs | • Some patients report not being given an action plan as a reason for not using one55 (P). |
| • Some carers prefer their own judgement to using peak flow51 (Ca). Some adult patients reported peak flow monitoring to be ‘nonsense’ or ‘frightening’73 (P). | |
| • Adolescent patients do not use action plans if they believe their asthma does not need further management.33,71 Some are not willing to use electronic action plans that involve monitoring over long periods71 (Ch/ R). | |
| • African American women report that mood and memory problems can be a barrier to remembering to follow their asthma action plan35 (P). | |
| • Occasionally nurses believe action plans can be dangerous (for intelligent people) as patients may manage on their own for too long, not return for their review and so encounter severe difficulties11 (HCP)c. | |
| • Some GPs regard actions plans as irrelevant,11 impractical,44 and time-consuming.69 While they use action plans for other conditions, such as diabetes they do not use them for asthma44 (HCP). | |
| • Some GPs have reservations over using guidelines as they are not useful for medication adjustment and are concerned that they are based on out-of-date evidence46 (HCP). | |
| • Use of action plans by HCPs ranges from little use to most of the time39,46 (HCP/R), and some patients report having never seen or possessed a written asthma plan39,73 (P). | |
| • Despite attending regular asthma reviews, some adults with asthma were sceptical about the interest, knowledge, and understanding demonstrated by GPs59 (P). | |
| • Some patients and GPs have low self-efficacy for using action plans. This mainly applies to patients who have not accepted their diagnosis55 and GPs who infrequently prescribe action plans69 (P, HCP). | |
| • Some patients feel action plans need to be ‘modified’ in some way (unspecified), to meet the needs of those with severe asthma61 (P). Other patients feel that they can decide their own plan of action without consulting their GP for review until they decide they should33,39,59,73 (Ch/P), and perceive generic action plans as patronising or condescending59 (P). | |
| • Some HCPs from Singapore follow their own action plan, when they cannot find the standard action plan given to them in training69 (HCP). | |
| Perceived relevance of action plans and guidelines for particular types of people | • Some patients think action plans are good for patients with asthma they perceive to be worse than their own, or for ‘others’, but not relevant to them personally11,71 (P). |
| • Some GPs feel action plans are best for motivated11,69 or educated69 patients and not appropriate for newly-diagnosed patients, those already self-managing,11 those with poorly controlled asthma,46 non-compliant patients or patients that do not understand them11,46 (HCP). | |
| • Some HCPs feel that guidelines are only useful to newly qualified staff46 (HCP). | |
| • The amount of importance that carers place on consulting a GP depends on the carers' level of concern, and their confidence and experience in using a written action plan70 (Ca, R). | |
| Positive views of interventions (Internet, text message, booklet/DVD and pharmacist telephone) | • Users reported being satisfied with an Internet intervention68 (P, HCP). Some patients saw it as useful for identifying triggers and monitoring symptoms50 (P). Some GPs believe it benefited their patients, in understanding asthma, reducing symptoms and improving compliance. They think it was also good for record keeping and performing calculations68 (HCP). |
| • Some patients, including those with intellectual disabilities, liked the convenience of being monitored by a text message diary or mobile phone alarm, as it gives them a sense of control whilst being supported34,60,67 (P). Adults and Older Adults found it useful to create reminder systems and routines to facilitate medication use40,62 (P). | |
| • Some Urdu speaking patients view written information booklets on managing asthma and videos in Urdu as useful and helpful45 (P). Young African American patients felt that an online programme with email and text messages would be helpful and desirable43 (P). | |
| • Some patients reported that a pharmacist telephone intervention was helpful and positive in giving SM education, for asking questions, and for getting feedback25 (P). | |
| • Internet-based self-management interventions were viewed by patients as useful for identifying triggers and observing symptoms; instant feedback regarding lung function; and reacting to changes that occur in asthma status.71 Email communication and electronic consultations were viewed as useful71 (P/Ch). | |
| • Internet interventions were better accepted by those with poorly controlled asthma. This group was more willing to use an electronic action plan and was not concerned about the time taking to monitor symptoms68,71 (R). | |
| Negative views of interventions (Internet, text message, booklet) | • Some patients react to alert messages to increase medications with disbelief and consequently do not adhere to taking increased dosages.68 They would like more information on side effects of medications68 (P). |
| • Lack of confidence with computers can hinder use of Internet interventions by patients and GPs68 (P, HCP). | |
| • Patients gave feedback on what they did not like about a text message service (frequency and type of message), suggesting improvements to its design67 (P). | |
| • Although some patients with severe asthma value information gained from websites, lay sources, medical journals, and information booklets, some prefer information from a specialist, using down-to-earth language30,60,61 (P). |
a Interventions aside from taking medications and avoiding triggers (i.e., action plans, guidelines and research interventions)
b Type of person who expressed their viewpoint (P patient viewpoint, HCP health care professional viewpoint, Ca carer viewpoint, Ch child/adolescent’s viewpoint, R researcher’s viewpoint, S school personnel’s viewpoint)
c Note that this viewpoint may be out of date as the study was published in 200011