Challenges in implementation of asthma self-management in primary care setting

Aim Supported self-management for asthma is an effective intervention but challenging to implement in routine practice. We aimed to explore healthcare professionals’ perspectives of the challenges they face implementing self-management in their primary care setting. MethodWe recruited primary healthcare professionals (HCPs) serving a semi-urban district of Klang, Malaysia in 2019 to conduct focus groups discussions. Semi-structured interview guides were used to facilitate interviews which were audio-recorded, and transcribed verbatim. A thematic approach was used to analyse the data. Results We conducted six focus group discussions with 26 healthcare professionals (family medicine physicians (n=5), medical officers (n=5), medical assistants (n=4), pharmacists (n=4), assistant pharmacists (n=4) and nurses (n=4)). The challenges in implementing asthma self-management in clinical practice include challenges related to healthcare professionals (HCPs), perceived patients’ issues and the asthma self-management tool. HCPs described constraints of time and manpower, low motivation in the delivery of self-management practices in consultations, lack of awareness about the potential of self-management and need for specific skills-based training as the HCPs related challenges. Patient related challenges included low levels of health literacy and language barriers which hindered comprehensive understanding of asthma self-management plans. Other perceived patients’ issues were related to patient’s self-management practices such as lack of priority in managing their asthma and non-adherence to documentation of asthma diaries. In addition, currently available asthma self-management tools were considered too wordy for patients to understand, limited to English and Malay, and often not readily available in consultation rooms. Conclusion The factors that contributed to the challenges of implementation of asthma self-management were multifactorial, and at least some are modifiable. Interventions to improve patient’s empowerment and asthma self-management in primary care setting will need to adopt a comprehensive approach that encompasses the healthcare system, HCPs and patients. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Declaration of InterestNIHR Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care References and Clinical Trial Registry Information