Considering the role of culture on asthma self-management behaviour: Using the Bangladeshi and Pakistani exemplar populations
Abstract
Background: Self-management improves asthma outcomes and has been widely recommended in guidelines, though interventions are less effective in UK South Asian communities. Asthma, self-management and South Asian sociocultural contexts are all dynamic, therefore making sense of these factors is necessary. This thesis aimed to understand the role of two UK South Asian subcultures (Bangladeshi and Pakistani) on asthma self-management, which can help set the foundations for developing holistic bottom-up interventions.
Method: Using the MRC guidance on developing complex interventions, this thesis: i) narratively synthesises 16 RCTs (17 papers) in South Asian and Black populations to explore the extent to which variance in self-management is due to ethnicity and/or various sociocultural contexts, ii) semi-structured interviews with 27 Bangladeshis and Pakistanis with asthma to understand the role of culture in self-management, and iii) semi-structured interviews with nine healthcare professionals to understand their perspective on providing supported self-management to these communities.
Result: i) Sociocultural contexts (including whether individuals were from a minority or indigenous population) was important for developing interventions targeted at different cultures, but bottom-up interventions were rare. Ethnic minority interventions (South Asian and African-American) were less effective than interventions delivered in indigenous Indian populations, ii) The perspectives of individuals with asthma showed understanding the Bangladeshi and Pakistani self (the person) in self-management was helpful to understand various forms of self-management around the body, context, and distribution of knowledge/discourses, iii) The perspective of healthcare professionals showed that they mostly made universal assumptions about culture and adapted supported self-management accordingly (in the absence of adequate cultural training).
Conclusion: A holistic approach to developing bottom-up interventions, considering the perspective of Bangladeshi and Pakistani individuals and healthcare professionals are needed. Some intervention ideas that can be explored further are: medicine adherence during Ramadhan, psychological interventions (e.g. religious coping and dealing with emotions), raising physical/symbolic self-consciousness (e.g. beliefs), better service/language provisions and cultural training/information for healthcare professionals.
Authors
Ahmed, SalinaCollections
- Theses [4125]