# Exploring the perspectives of healthcare professionals on providing supported asthma self-management for Bangladeshi and Pakistani people in the UK

## TL;DR

Healthcare professionals in the UK adapt asthma self-management support for Bangladeshi and Pakistani patients based on cultural perceptions, but they face challenges due to lack of training and resources.

## Contribution

The study reveals how healthcare professionals use personal and professional perceptions of culture to adapt asthma care for ethnic minority groups in the absence of formal training.

## Key findings

- Professionals attempt to tailor asthma self-management support based on perceived cultural factors like family involvement.
- There is a consensus that training in cultural competence and providing culturally relevant materials are needed to improve care.
- Adaptations are constrained by organizational limitations and gaps in cultural knowledge among professionals.

## Abstract

Self-management support improves asthma outcomes and is widely recommended in guidelines, yet it is poorly implemented in routine practice. There may be additional challenges in the context of ethnic minority groups, where making sense of culture may be necessary. This study aimed to explore the perspectives of healthcare professionals on supporting UK Bangladeshi and Pakistani patients to self-manage their asthma.

One-to-one semi-structured interviews with professionals (primary and secondary care; medical and nursing) who routinely provide asthma care to Bangladeshi or Pakistani patients. Topics addressed included perceptions of professionals in supporting patients with asthma self-management and ideas for improving culturally competent care. Data were analysed thematically.

Nine professionals, from a range of ethnic backgrounds, with considerable experience of treating patients from these communities were interviewed. Despite organisational restrictions (language and time/resources) and expressed gaps in cultural knowledge and training, all interviewees reported attempting to tailor support according to culture. They used their perception of the patient’s culture (e.g., big families and family involvement), integrated with their perception of patients’ ability to self-manage (e.g., degree of responsibility taken for asthma), to formulate theories about how to culturally adapt their approach to supported self-management, e.g., supporting barriers in understanding asthma. There was consensus that gaps in cultural knowledge of professionals needed to be addressed through training or information. Interventions recommended for patients included basic education, group meetings, and culturally relevant action plans.

In the absence of formal training and constrained by organisational limitations, self-management support was adapted based on personal and professional perception of culture. These ideas were based on experience and formulated a chain of reasoning. Professionals recognised the limitations of this approach and potential to overgeneralise their perceptions of culture and adaptations of supported self-management. Interventions were desired and need to address professional training in cultural competence and the provision of culturally relevant materials.