Table 1 Table of included studies
Study (country) | Study type | Population | Barriers | Facilitators | Critique |
|---|---|---|---|---|---|
Kuehni3 (UK) | Prevalence survey | 6080 children aged 1-4 | Possible under-treatment with steroids | NS | High response rate |
Hazir15 (Pakistan) | Questionnaire based interview | 200 parents/carers of children with asthma aged 2–13; attended hospital asthma clinic between 3 m-7 y | Lack of understanding of medication use, food beliefs, social stigma & poor child self-esteem | Lack of awareness not significantly related to socioeconomic or educational background. Community strategies to raise awareness needed. | Pakistan is an ethically, culturally & socially diverse country. Hospital based study therefore may not reflect true situation in community. |
Shivbalan16 (India) | Questionnaire survey | 100 children aged 2–15 with total >4 wheeze episodes, 2 wheeze episodes in the last 6 months with at least 2 ED visits and 1 hospitalisation. | Lack of knowledge and acceptance about asthma, poor understanding of aetiology & prognosis, misconceptions about long-term medications, social stigma & reliance on GPs for information | Awareness of triggers | No clear details on ethical approval or eligible/recruited numbers. Majority of participants from same socioeconomic status therefore may not be representative |
Haque17 (Pakistan) | Questionnaire survey pre/post seminar | 82 GPs registered with the College of Family Medicine | Lack of knowledge by healthcare professionals | NS | Participants were GPs who voluntarily attended an educational programme & therefore results may be biased towards motivated GPs |
Gautam18 (India) | Questionnaire survey | 157 GPs registered with the Delhi Medical Association | Knowledge gaps in different GPs. Includes diagnosis, misconceptions about food and exercise avoidance and parental smoking effects | NS | No clear inclusion/exclusion criteria & mention questionnaire validity. Non-respondent bias may be present–43 (21.5%) GPs refused. |
Lai19 (India) | Questionnaire survey | 85 children with asthma ages 6–17 with minimum 2 years since symptom onset. | Poor physician-parent communication, social stigma, misconceptions about food avoidance & beliefs that modern medicines cause harm | Parents keen to learn & parental recognition of importance of treating asthma | No clear recruitment methodology & mention of questionnaire validity. Participants enrolled in asthma clinic so biased towards those receiving medical care. |
Ormerod20 (UK) | Prevalence survey | 1783 adults and children with asthma aged 0–70 registered with participating GP practice | Asthma under-diagnosis with possible under-recognition & reporting | NS | No clear recruitment methodology and no sample size calculations. Findings reflect Blackburn GPs so may not be generalisable. |
Duran-Tauleria21 (UK) | Questionnaire survey | 14490 children aged 5–11 with respiratory symptoms including asthma, wheeze & bronchitis66 | NS | Ethnic monitoring and targets for specific populations to monitor adherence to clinical guidelines & indicators to monitor inequalities in asthma treatment in minority ethnic communities | No clear sampling & recruitment methodology & no clear inclusion/exclusion criteria. |
Cane22 (UK) | Focus groups | 66 mothers aged 22–45 from Bangladeshi, White or Black Caribbean backgrounds. | Different (sometimes inaccurate) understandings of asthma, use of alternative medications, delay in seeking Western medical help & stigma | NS | Study based on mothers’ perception of video of child with an asthma attack with lack of further content. Unclear analysis methodology. No data on socioeconomic or educational background collected. |
Smeeton23 (UK) | Questionnaire survey | 150 parents of children with asthma aged 3-9 | Stigma, erroneous beliefs & choosing not to give medications | NS | Clear recruitment and sampling methodology with clear analysis. High proportion of SA participants born outside UK with low education level & therefore may impact results. |
Singh24 (India) | Questionnaire survey | 1012 adults and children with asthma | Lack of knowledge about asthma, failure of recognising warning symptoms, beliefs in permanent cure, use of complementary medicine & treatment non-adherence | Children preferred inhalers whereas adults preferred oral medications | No data on questionnaire validity. No clear eligibility, inclusion & exclusion criteria. Use of numerous closed questions. Study and analysis included both adults and children. |
Mittal25 (India) | Questionnaire survey | 52 child–parent pairs; children aged 6–15 diagnosed with asthma | Parent and child ability to perceive symptom severity (influenced by child’s age), cigarette smoke exposure and asthma severity | NS | Unclear reason of chosen sampling and recruitment method. |
Michel26 (UK) | Questionnaire survey | 4236 children aged 6-10 | English as second language & deprivation | Higher maternal education. | Parents received three study questionnaires so may have had a learning effect. Low response rates of 52% of Whites & 40% of South Asians. |
Panico27 (UK) | Cohort study | 14630 singleton infants aged 3 whose mothers participated in the survey | Language & maternal migration – suggests the lack of UK familiarity & language skills leads to underreporting of asthma | NS | Despite large study size small SA group samples (5%). Barriers are inferred. Children of mixed ethnicity classified according to the EM parent’s group and may lead to effect attenuation. |
Carey28 (UK) | Prevalence survey | 847 children aged 8–11 with asthma, atopy or bronchial hyperreactivity | Western diet associated with more hyperreactivity | Asian diet appears protective | No data on questionnaire reliability and validity. |