Barriers and facilitators to effective self-management of asthma - a systematic review and thematic synthesis and The development of ‘Balance Retraining’: an online intervention to support the self-management of dizziness in adults aged 50 and above Seminar

Introduction and Objectives: Self-management is an established approach to controlling asthma, recommended in guidelines. Despite the reported effectiveness of self-management, its promotion, uptake and use among patients, carers, and health-care professionals remain low. We conducted a systematic review and thematic synthesis of qualitative research into self-management in adults, children and adolescents with asthma. Our objective was to identify the perceived barriers and facilitators associated with reduced or improved effectiveness of asthma self-management.

Method: Electronic databases and British Thoracic Society guidelines were searched for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in adults, children and adolescents with asthma. We assessed the methodological strengths of the studies using the Critical Appraisal Skills Programme (CASP) tool for qualitative studies, and conducted a thematic synthesis of included studies.

Results: Of the 1532 studies initially identified, 34 papers were included in the review. Thematic synthesis identified 10 overarching themes which suggest that barriers and facilitators of self-management included the perceived quality of the relationship between health-care professionals and patients, the perceived adequacy of education around self-management and medications, and positive and negative beliefs about asthma with regards to self-management and existing interventions. Self-management could also be helped or hindered by the amount and type of social support and perceived ease of access to healthcare. In addition, having a co-morbidity, mood/anxiety problems, and encountering professional barriers within the health care system (such as consultation time and access to lung function testing), are perceived to hinder successful self-management of asthma.

Conclusion: Perceived barriers and facilitators occur at the level of individuals with asthma (and carers), health-care professionals, and organisations. These findings contribute to our understanding of why existing self-management interventions may not always be effective, and can be used to inform future study into areas where further intervention may improve the adoption of self-management of asthma. For example, future work could include addressing patient and carer beliefs in educational interventions and decisions involving treatment, or greater use of pharmacist educators, patient advocates, and technological interventions.

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The development of 'Balance Retraining': an online intervention to support the self-management of dizziness in adults aged 50 and above As people become older, experiencing dizziness becomes more common and can lead to falls, fear, and poor quality of life. Specific exercises that retrain the balance system to overcome dizziness have been shown to be very effective in reducing self-reported symptoms, but very few are currently taught these. Given older adults’ increasing use of computer technologies and the internet, we have developed an interactive online intervention incorporating these exercises to support individuals in reducing their dizziness symptoms. This talk will discuss the development of Balance Retraining; a weekly module-based intervention, for use amongst adults aged 50 and over, that includes: video demonstrations of core exercises; advice personalised to users’ symptoms; exercise reminders; and support in dealing with fear and stress that exacerbate symptoms.

The talk will draw upon our development-phase qualitative investigation of older adults’ experiences of using the intervention over a six week period. The study investigated users’ engagement with the intervention and their perceptions of its accessibility and appearance via think aloud sessions and semi-structured interviews. The findings revealed a positive reception with regards to the look and feel of the intervention and many users reported noticing improvements or feeling more in control of their symptoms. User feedback informed minor amendments of the intervention prior to the full primary care RCT that commenced in August 2013. The RCT aims to evaluate the effectiveness and cost effectiveness of the intervention.