Implementing patient counselling using Pictorial Personalised Asthma Action Plan in Government Primary Care Clinics in Malaysia: Challenges and potential solutions

Introduction: Asthma self-management counselling is recommended for asthma management but it is not routine practice in public primary care clinics in Malaysia. We developed a pictorial personalised asthma action plan (pictorial-PAAP) and are conducting a randomised controlled trial to compare its effectiveness in improving asthma control against text-based PAAP. In this paper, we present the challenges faced by health care providers (HCPs) during the use of the pictorial-PAAP for counselling after the RCT and the potential solutions suggested. Methods: We used qualitative methods to explore HCPs’ concerns and challenges. HCPs from four primary care clinics in the Klang District who were involved in delivering the PAAP were recruited for in-depth interviews or focus group discussions (FGD). The interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: Four focus groups (two pharmacists and seven medical officers), and one in-depth interview (family medicine specialist) were conducted. A major challenge faced was limited time which could be reduced with visual aids though limited resources to print the coloured pictorial-PAAP could be a challenge. HCPs suggested using pictorial-PAAP in smartphones and reserving the hard copy for those without smartphones. Availability in other local languages is still needed, though pictures could help overcome language barriers. There were concerns about HCPs who were not familiar with the pictorial-PAAP counselling, suggesting that training would be an important implementation strategy. The HCPs also recommended a dedicated asthma clinic, enabling a more systematic and focused approach to asthma management. Conclusion: Training of HCPs to the use of pictorial-PAAP coupled with a dedicated asthma clinic could facilitate the implementation of asthma self-management counselling in public primary care clinics. Funding: This research was funded by the UK National Institute for Health and Care Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); NIHR132826) 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 Government.