Healthcare providers’ experiences in delivering the pictorial and text-based personalised asthma action plan

Introduction: Asthma self-management improves clinical outcomes. We developed and implemented in primary care practice a pictorial personalised asthma action plan (pictorial-PAAP) to facilitate supported asthma self-management and aimed to compare its effectiveness with text-based PAAP (text-PAAP). This paper presents the healthcare providers’ (HCPs) experience and perception regarding the use of both pictorial- and text-based asthma action plans during patient counselling. Methods: HCPs from four primary care clinics with experience of delivering and counselling patients on self-management using both pictorial-PAAPs and text-PAAPs were recruited for in-depth interviews or focus group discussions (FGD). The interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: Four FGD (two pharmacists and seven medical officers), and one in-depth interview (family medicine specialist) were conducted. HCPs found both pictorial-PAAP and text-PAAP could potentially improve asthma control when coupled with education and promotion of patients’ adherence. Pictorial-PAAP was preferred as the visual elements were engaging and facilitated explanations. The use of traffic light colours in the pictorial-PAAP aided patient recognition and recall making it easier for patients to understand and more user-friendly compared to the text-PAAP. In addition, the pictorial-PAAP could save time as patients could grasp the instructions quickly through visuals and help overcome language barriers by conveying information through images. During follow-ups HCPs perceived that patients who were given pictorial-PAAPs had better retention of information. There was interest in expanding the use of pictorial-PAAP to paediatric populations. The content of both asthma action plans was generally useful but could be improved with larger fonts and additional details on triggers and treatment options. Conclusion: HCPs favoured the use of Pictorial-PAAP compared to text-PAAP for counselling on self-management. Pictorial-PAAP facilitate the counselling process and enhances patients’ understanding and retention of information on self-management. 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.