Adapting a School-Based Asthma Programme for LMICs: Insights from Bangladesh, Indonesia, India, and Pakistan

Introduction: Despite WHO recommendations that school health services should include asthma (self-management education for children; first aid training for school staff), few low- and middle-income countries (LMICs) have school-based asthma programmes. We aimed to adapt a programme, developed in Malaysia, to improve asthma care for children in Bangladesh, Indonesia, India, and Pakistan. Methods: We followed a mixed-methods approach to tailor the programme to each local context. The study comprised of three phases: 1. Qualitative Exploration: Assessing a school-based asthma intervention's rationale and contextual fit. 2. Programme Adaptation: Tailoring the intervention to suit each local context. 3. Feasibility Testing: Evaluating the practicality and acceptability of the adapted intervention. To identify children with asthma, schools sent letters to parents inquiring about asthma symptoms or prior asthma diagnoses of their children. Local stakeholders including children with asthma, their parents, school staff, and healthcare professionals were involved to ensure the programme aligned with community needs and contexts. Results: The work is on-going, but challenges include: • Less than 1% of children self-reported asthma symptoms or physician-diagnosed asthma. Qualitative exploration is ongoing to investigate possible reasons, such as presence of asthma symptoms, lack of asthma awareness, and reluctance to disclose symptoms or diagnosis. • Difficulties in conducting research in schools e.g. low prioritization of research participation and scheduling conflicts. Preliminary findings suggest the need for intervention adaptations focused on raising awareness, reducing stigma, and encouraging symptoms disclosure. Discussion: The prevalence of self-reported asthma symptoms and diagnoses in schools is significantly lower than figures reported in prior studies. The reasons for this discrepancy remain unclear and are being explored through ongoing qualitative investigations. Insights from this phase will inform intervention adaptations aimed at improving awareness and disclosure. Phase 3 will evaluate the feasibility of the adapted programme, with findings guiding future trials and broader implementation strategies. Funding: This research was funded by NIHR 16/136/109 and NIHR132826 using UK international development funding 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 government.