Insights from Photovoice on the impact of socio-cultural factors on people with asthma and limited health literacy in Malaysia.

Aim: Limited health literacy is associated with poor adherence to self-management activities and poor clinical outcomes. In vulnerable groups such as people with asthma and limited health literacy, socio-cultural pressures may have affected overall health including psychological health. People with limited health literacy may not be able to communicate their psychological health aspect well, verbally. Using the arts-based methodology, Photovoice, we aimed to explore the views and experiences of people with asthma and limited health literacy on managing their condition.Methods: We purposively sampled adults ³18 years, with asthma and limited health literacy (using health literacy scale, HLS-Q47 (Malay version)) from five primary healthcare clinics in Malaysia. The interviews used a semi-structured topic guide in participants preferred language. Participants were additionally invited to participate in ‘Photovoice’: (1) One-week photo-taking (2) Post-photo interview. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results: Twenty-six participants provided in-depth interviews. Eight of these participants completed photovoice activities which provided further insights to the initial interviews. Participants faced multiple challenges to conform to expected social roles (i.e. care-giving role of a daughter-in-law) which may affect their health-seeking behaviour and asthma control. Gender narratives dominate socio-cultural expectations i.e. strong man and obedient wife. Religion shaped experiences of and attitudes towards health, as well as death. These factors influenced how self-management was viewed and practised. Unmet social expectations and constant fear of death led to isolation which significantly impacts on mental health.Conclusion: Context-specific psychosocial factors influence asthma self-management practices and control. Photovoice allowed further understanding of these psychosocial aspects; giving voice to people with limited health literacy in a multicultural society. A participant who attended the RESPIRE annual meeting in Kuala Lumpur was supported to discuss a Photovoice booklet with key stakeholders and senior guests of the meeting. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest HS is a PhD student with 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