Barriers to implementing asthma self-management in Malaysian primary care

Summary

A RESPIRE qualitative study has identified significant challenges in the implementation of supported asthma self-management in primary care practice in Malaysia.

https://www.nature.com/articles/s41533-021-00250-y

Authors

Lee PY, Cheong AT, Ghazali SS, Salim H, Wong J, Hussein N, Ramli R, Pinnock H, Liew SM, Hanafi NS, Bakar AIA, Ahad AM, Pang YK, Chinna K, Khoo EM

Findings

26 Malaysia-based healthcare professionals were recruited from an asthma training workshop. Key perceived barriers to self-management were:

Capability: lack of training

Opportunity: heavy workloads that limited available time; limited access to asthma action plans and poor recording in medical records that made it unclear if a self-management plan had already been implemented.

Motivation: lack of awareness regarding the benefits of asthma self-management and concerns that it would be difficult empower patients

Additionally, there were contextual barriers:

Societal context: healthcare professionals reported low education and health literacy levels particularly among older patients. This was worsened by language barriers.

Organisational context: asthma is treated episodically, it is not set up for chronic disease management; therefore the lack of personnel, budget and time mean self-mangement is sidelined

Implications

The lead author Ping Yein Lee says:

“The factors that contributed to the challenges of implementing asthma self-management in a Malaysian primary care setting were multifactorial. Interventions will need to adopt a comprehensive approach tailored to the local healthcare system and address the societal context.”

The study suggests that training and extending assistant pharmacist and nurse roles within healthcare may alleviate capability and opportunity-related barriers. Improved training can improve motivation. To address this, blended learning has been proposed because it increases accessibility and interactivity.

Culturally appropriate comprehensive education tailored to education and literacy levels about asthma and promotion of self-management will be needed, including the use of pictures and videos and the provision of multilingual resources.