Effectiveness of Educational Interventions on Asthma Self-Management in Punjabi and Chinese Asthma Patients: A Randomized Controlled Trial

Abstract

Background. Asthma tends to be less well controlled among ethnic minority groups, and its prevalence in new immigrants increases significantly the longer they are in Canada; mainly due to their lack of familiarity with English and difficulty understanding information regarding the disease, health literacy, cultural issues, housing conditions, and lack of access to appropriate care services. Objective. To explore the effectiveness of different formats of culturally relevant information and its impact on asthma patients’ self-management within the Punjabi, Mandarin, and Cantonese communities. Methods. Using a participatory approach, we developed and tested knowledge and community educational videos (with similar information, but used a different approach, i.e., scientific vs. colloquial) and a pictorial pamphlet. A total of 92 physician-diagnosed adult asthma patients (47 Chinese and 45 Punjabi) were assigned at random to three experimental groups (watched one or both videos) and one comparison group (read pictorial pamphlet) and participated in three in-person interviews and one telephone interview within a 9-month period. Patients received education on asthma self-management via videos and pamphlet and outcomes, including their knowledge of asthma triggers (environmental-related and behavioral-related triggers) and symptoms; inhaler use skills and patient-reported medication adherence were measured. Results. Knowledge of asthma symptoms, inhaler use, and understanding of physician’s instructions improved significantly from pretest to 3 months post-intervention follow-up among all participants. Conclusions. Participants performed significantly better at follow-up than they did at baseline assessment, with the most notable improvements observed in the group that watched both community and knowledge videos. The results suggest that short, simple, culturally, and linguistically appropriate interventions can promote knowledge gain about asthma and improve inhaler use that can be sustained over the short term. Such interventions that provide authentic learning materials that draw on patients’ life experiences and sociocultural context can overcome certain limitations of conventional patient education approaches.

The ClinicalTrials.gov Registry Identifier is: NCT01474928

• asthma
• cultural background
• educational materials
• instructional video
• patient education handout

Acknowledgements

We thank the community members, facilitators, immigrant serving agencies, and key informants from Punjabi and Chinese communities in the GVA who helped us from the initial steps of this research. We also thank the Chinese and Punjabi physicians for their contribution to the development of the educational videos. In addition, we acknowledge the support provided by Mr. James Hatch in comprehensively proofreading this manuscript and Ms. Emma FitzGerald for completing the patient educational pamphlet illustrations. This project was funded by the Canadian Institutes of Health Research (CIHR) and partly from the Centre for Lung Health at The University of British Columbia, Vancouver.

Declaration of Interest

We declare that there is no conflict of interest in terms of ownership of shares, consultancy, speaker’s honoraria, or research grants from commercial companies or professional or governmental organizations with an interest in the topic of the paper (the International Committee of Medical Journal Editors (ICMJE) form for Disclosure of Potential Conflicts of Interest from the corresponding author and the coauthors will be also sent to the journal separately).

Notes

The ClinicalTrials.gov Registry Identifier is: NCT01474928