A pictorial asthma action plan to improve asthma control in Malaysian adults: preliminary results of a feasibility study

Aim Written action plans improve health outcomes but can be difficult for people with limited health literacy to understand. There is increasing evidence that pictograms may facilitate use of these plans. We aim to assess the feasibility of incorporating a pictorial asthma action plan for adults with asthma that is adapted to support self-management in Malaysia. Methods The study is ongoing in public primary care clinics. There are two phases:1) adaptation of the pictorial asthma action plan (PAAP) and 2) a mixed-methods, pre-post feasibility study including the feasibility of assessing costs. In the pre-post study, we recruited patients aged 18 years and above with physician-diagnosed asthma and on inhaled corticosteroids. Participants were provided with a PAAP, adapted to the Malaysian context, as part of their supported self-management. The primary outcome was asthma control (Global Initiative for Asthma (GINA) symptom control). Participants were followed-up at 1, 3 and 6 months. A logistic regression repeated measures analysis was conducted to determine the effect of the intervention on asthma control across the four time points. Ethical approval for this study was obtained from the Medical Research and Ethics Committee, Ministry of Health, Malaysia [NMRR-18-2683-43494]. Results The 3-month preliminary analysis showed the retention rates were 90% and 85% at 1- and 3-month follow ups, respectively. At baseline, the majority of the 70 participants were 40 year old and above (61%), had limited health literacy (61%), did not have a prior asthma action plan (60%) and had poor asthma control (60%). The proportion with good asthma control was 41% at 1-month follow-up (p=0.28) and improved significantly at 3-month follow-up from baseline (p=0.04).Conclusion The pictorial asthma action plan is a feasible tool to be used in supported self-management of adults with asthma. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This research was commissioned by the UK NIHR 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 The trial registration is ISRCTN87128530.