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Meta-Analysis
. 2017 Aug 22;8(8):CD006580.
doi: 10.1002/14651858.CD006580.pub5.

Culture-specific programs for children and adults from minority groups who have asthma

Gabrielle B McCallum  1 , Peter S Morris, Ngiare Brown, Anne B Chang
Affiliations
Meta-Analysis

Culture-specific programs for children and adults from minority groups who have asthma

Gabrielle B McCallum et al. Cochrane Database Syst Rev. .

Abstract

Background: People with asthma who come from minority groups often have poorer asthma outcomes, including more acute asthma-related doctor visits for flare-ups. Various programmes used to educate and empower people with asthma have previously been shown to improve certain asthma outcomes (e.g. adherence outcomes, asthma knowledge scores in children and parents, and cost-effectiveness). Models of care for chronic diseases in minority groups usually include a focus of the cultural context of the individual, and not just the symptoms of the disease. Therefore, questions about whether tailoring asthma education programmes that are culturally specific for people from minority groups are effective at improving asthma-related outcomes, that are feasible and cost-effective need to be answered.

Objectives: To determine whether culture-specific asthma education programmes, in comparison to generic asthma education programmes or usual care, improve asthma-related outcomes in children and adults with asthma who belong to minority groups.

Search methods: We searched the Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, Embase, review articles and reference lists of relevant articles. The latest search fully incorporated into the review was performed in June 2016.

Selection criteria: Randomised controlled trials (RCTs) comparing the use of culture-specific asthma education programmes with generic asthma education programmes, or usual care, in adults or children from minority groups with asthma.

Data collection and analysis: Two review authors independently selected, extracted and assessed the data for inclusion. We contacted study authors for further information if required.

Main results: In this review update, an additional three studies and 220 participants were added. A total of seven RCTs (two in adults, four in children, one in both children and adults) with 837 participants (aged from one to 63 years) with asthma from ethnic minority groups were eligible for inclusion in this review. The methodological quality of studies ranged from very low to low. For our primary outcome (asthma exacerbations during follow-up), the quality of evidence was low for all outcomes. In adults, use of a culture-specific programme, compared to generic programmes or usual care did not significantly reduce the number of participants from two studies with 294 participants for: exacerbations with one or more exacerbations during follow-up (odds ratio (OR) 0.80, 95% confidence interval (CI) 0.50 to 1.26), hospitalisations over 12 months (OR 0.83, 95% CI 0.31 to 2.22) and exacerbations requiring oral corticosteroids (OR 0.97, 95% CI 0.55 to 1.73). However, use of a culture-specific programme, improved asthma quality of life scores in 280 adults from two studies (mean difference (MD) 0.26, 95% CI 0.17 to 0.36) (although the MD was less then the minimal important difference for the score). In children, use of a culture-specific programme was superior to generic programmes or usual care in reducing severe asthma exacerbations requiring hospitalisation in two studies with 305 children (rate ratio 0.48, 95% CI 0.24 to 0.95), asthma control in one study with 62 children and QoL in three studies with 213 children, but not for the number of exacerbations during follow-up (OR 1.55, 95% CI 0.66 to 3.66) or the number of exacerbations (MD 0.18, 95% CI -0.25 to 0.62) among 100 children from two studies.

Authors' conclusions: The available evidence showed that culture-specific education programmes for adults and children from minority groups are likely effective in improving asthma-related outcomes. This review was limited by few studies and evidence of very low to low quality. Not all asthma-related outcomes improved with culture-specific programs for both adults and children. Nevertheless, while modified culture-specific education programs are usually more time intensive, the findings of this review suggest using culture-specific asthma education programmes for children and adults from minority groups. However, more robust RCTs are needed to further strengthen the quality of evidence and determine the cost-effectiveness of culture-specific programs.

PubMed Disclaimer

Conflict of interest statement

GBM: none known.

PSM: none known.

NB: none known.

ABC: was an author in one of the included studies.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Paediatric studies, outcome: 1.1 Number of participants who had one or more exacerbation over the study period.
4
4
Forest plot of comparison: 1 Paediatric studies, outcome: 1.2 Mean number of exacerbations over 52 weeks (exacerbation rate).
5
5
Forest plot of comparison: 1 Paediatric studies, outcome: 1.3 Severe exacerbations requiring hospitalisation over the study period.
6
6
Forest plot of comparison: 1 Paediatric studies, outcome: 1.4 Improved asthma control.
7
7
Forest plot of comparison: 1 Paediatric studies, outcome: 1.8 Parent description of AAP when child is well.
8
8
Forest plot of comparison: 2 Adult studies, outcome: 2.1 Asthma exacerbations during follow‐up.
9
9
Forest plot of comparison: 2 Adult studies, outcome: 2.2 Change in AQLQ.
1.1
1.1. Analysis
Comparison 1 Paediatric studies, Outcome 1 Number of participants who had one or more exacerbation over the study period.
1.2
1.2. Analysis
Comparison 1 Paediatric studies, Outcome 2 Mean number of exacerbations over 52 weeks (exacerbation rate).
1.3
1.3. Analysis
Comparison 1 Paediatric studies, Outcome 3 Severe exacerbations requiring hospitalisation over the study period.
1.4
1.4. Analysis
Comparison 1 Paediatric studies, Outcome 4 Improved asthma control.
1.5
1.5. Analysis
Comparison 1 Paediatric studies, Outcome 5 Asthma control questionnaire.
1.6
1.6. Analysis
Comparison 1 Paediatric studies, Outcome 6 Improvement in carer's asthma QoL scores (parent/carer PACQLQ).
1.7
1.7. Analysis
Comparison 1 Paediatric studies, Outcome 7 Change in Carers' Asthma QoL (PACQLQ).
1.8
1.8. Analysis
Comparison 1 Paediatric studies, Outcome 8 Parent description of AAP when child is well.
1.9
1.9. Analysis
Comparison 1 Paediatric studies, Outcome 9 Self‐reported medication adherence (brief medication questionnaire).
1.10
1.10. Analysis
Comparison 1 Paediatric studies, Outcome 10 Asthma Knowledge Factors.
2.1
2.1. Analysis
Comparison 2 Adult studies, Outcome 1 Asthma exacerbations during follow‐up.
2.2
2.2. Analysis
Comparison 2 Adult studies, Outcome 2 Change in AQLQ.
2.3
2.3. Analysis
Comparison 2 Adult studies, Outcome 3 Asthma Knowledge Factors.
See this image and copyright information in PMC

Update of

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Bailey 2009a
    1. Bailey EJ, Cates CJ, Kruske SG, Morris PS, Chang AB, Brown N. Culture‐specific programs for children and adults from minority groups who have asthma. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD006580.pub3] - DOI - PubMed
Bailey 2009b
    1. Bailey EJ, Cates CJ, Kruske SG, Morris PS, Brown N, Chang AB. Culture‐specific programs for children and adults from minority groups who have asthma. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD006580.pub4] - DOI - PubMed

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