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Open Access Research article

A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children

Monica Lakhanpaul1*, Deborah Bird2, Logan Manikam3, Lorraine Culley4, Gill Perkins5, Nicky Hudson4, Joanne Wilson6 and Mark Johnson7

Author Affiliations

1 General and Adolescent Paediatrics Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK

2 Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK

3 Department of Primary Care and Public Health Sciences, 5th Floor, Capital House, 42 Weston Street, Guy’s, London SE1 3QD, UK

4 School of Applied Social Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK

5 Canterbury Christ Church University, North Holmes Road, Canterbury Kent CT1 1QU, UK

6 Leicester Children’s Community Services, Bridge Park Plaza, Bridge Park Road, Thurmaston, Leicester LE4 8PQ, UK

7 Mary Seacole Research Centre, De Montfort University, The Gateway, Leicester LE1 9BH, UK

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BMC Public Health 2014, 14:403  doi:10.1186/1471-2458-14-403

Published: 27 April 2014

Abstract

Background

South Asian children with asthma are less likely to receive prescriptions and more likely to suffer uncontrolled symptoms and acute asthma admissions compared with White British children. Understanding barriers are therefore vital in addressing health inequalities. We undertook a systematic review identifying explanatory factors for barriers and facilitators to asthma management in South Asian children. South Asians were defined as individuals of Indian, Pakistani or Bangladeshi descent.

Methods

Data Sources - Medline, HMIC, EMBASE, ASSIA, Web of Science, BNI, CINAHL, PsycINFO, OpenSIGLE, CRD, Scopus, NHS Evidence, Cochrane Library, Campbell Collaboration, RCPCH, ATS, ERS, Asthma UK, Google Scholar & Asthma Guidelines (BTS, GINA, ATS, Monash, NAEPP, Singapore & New Zealand) to August 2013.

Inclusion Criteria – Qualitative, quantitative or mixed methods research with primary focus on identifying explanations for barriers and/or facilitators to asthma management in South Asian children aged 0–18 years with diagnosed/suspected asthma and/or carers and/or healthcare professionals.

Data Extraction – Three authors independently reviewed, selected & extracted eligible articles with disagreements resolved by research team discussion.

Results

15 studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. Barriers and explanatory factors identified were:

1. Lack of asthma knowledge in families and healthcare professionals.

2. Under-use of preventer medications.

3. Non-acceptance/denial of asthma.

4. Over-reliance on Emergency Department management.

5. Communication problems.

6. Non-adherence to medication.

7. Use of complementary therapies.

Little facilitators regarding asthma management were identified.

Conclusions

Several key issues were identified as likely to be ethnic-specific to South Asian families, rather than a reflection of minority status: impact of parental and professional knowledge and beliefs, health service utilisation pattern explanations and the impact of prejudice and stigmatisation. Other explanations such as language barriers are not strictly ethnic specific but instead reflect a minority position.

Further research is required to identify why barriers exist, the mechanisms by which they impact on asthma management and how they can be overcome. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those that are related to being a minority will enable the application of generic system-wide interventions where ethnicity is not the issue and ethnically-tailored interventions where needed.

Keywords:
Asthma; Barriers; Facilitators; Asians