Developing Interventions to Tackle Ethnicity-based Disparities in Asthma Management in British South Asians (The TEAMS study)

Background Asthma affects around 8% of the British South Asian (SA) population. South Asian patients are more likely to be deprived, have higher risk of dust mite sensitisation and experience poor clinical outcomes compared to British White patients. Self-management is a key driver of asthma control and multiple factors such as cultural, social and religious, poor health literacy, delayed diagnosis and healthcare access have been postulated towards poor clinical outcomes amongst SAs. Culturally tailored/targeted supportive interventions might improve self -management in SA patients. Research Questions What are the facilitators and barriers in management of asthma in British SA patients, specifically with respect to timely diagnosis, engagement with the NHS, self-management, environment, socioeconomic status, literacy, cultural, religious and social factors? How can the current pathway of asthma management be modified to better support British SA patients? What are the views and perspectives of British SA patients and healthcare professionals (HCPs) towards culturally tailored/targeted supportive interventions for asthma? Objectives To determine the facilitators and barriers to uptake of asthma management amongst British SA patients? To understand the behaviour and attitude of HCPs in the management of asthma amongst British SA patients? To determine the views and perspectives of HCPs and British SA patients regarding the current management pathway. To develop culturally tailored/targeted supportive interventions for asthma management for British SA patients. Methods Patient population: SA patients (≥16 years; n=30 for workpackage-1 [WP1] and n= 8-10 for WP3) with physician diagnosed asthma recruited from primary and secondary care. An inclusive approach will be adopted to maintain wide sampling with respect to age, gender, ethnicity, religion, culture, literacy, English language proficiency, and socio-economic status. HCPs: Specialists, general practitioners, nurses and physiotherapists managing SA patients with asthma in primary and secondary care (n=30 for WP1 and n=8-10 for WP3). WP1: 1-2-1 semi-structured interviews with patients and HCPs to explore current practice and identify facilitators/barriers. An interview topic guide will be developed with patient partners, patient organisations and asthma specialists. Interviews will be transcribed verbatim and analysed using reflexive thematic analysis. WP2: Theoretical modelling of intervention development and drafting based on output from WP1. WP3: Refining intervention content from WP2 followed by piloting in SA patients and HCPs in focus groups. Input will also be sought from a panel of experts from key national stake holder societies and educators. Timelines Total – 14 months (regulatory approvals and pre-study workshop months 1-3; WP1: months 4-8; WP2: months 9-10; WP3: months 11-12 & writeup & dissemination: months 13-14). Anticipated Impact and Dissemination This study will pave the way for developing culturally tailored/targeted supportive interventions for SA patients with asthma and address inequalities of care and poor clinical outcomes. The output from this study will be disseminated via multiple channels including two major UK charities (Allergy UK and Asthma+Lung UK), national conferences and publications in medical journals. Output from this proposal will include a refined intervention content ready for production and evaluation in subsequent funded studies.