Background
South Asian children with asthma are less likely to receive prescriptions, more likely to suffer uncontrolled symptoms and admitted with acute asthma compared with White British children. Understanding and addressing barriers are therefore vital in addressing health inequalities. We therefore undertook a systematic review to identify explanatory factors which underlie barriers and facilitators to asthma management in South Asian children.
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 May 2010.
Inclusion criteria – Qualitative, quantitative or mixed 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
Fifteen studies encompassing 25,755 children, 18,483 parents/carers and 239 healthcare professionals were included. The barriers and explanatory factors identified were:
lack of asthma knowledge in families and healthcare professionals.
under-use of preventer medications
non-acceptance/denial of asthma
over-reliance on Emergency Department management
communication problems
non-adherence to medication
use of complementary therapies.
Little information regarding asthma management facilitators was identified.
Conclusion
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 move beyond only identifying what a barrier is and into identifying both what and why the barrier is and how it impacts on management. Furthermore, understanding the difference between barriers and explanations that are ethnic-specific and those 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.
