A pictorial asthma action plan to improve asthma control in Malaysian adults

Abstract

Aim: Written action plans improve health outcomes but can be difficult for people with limited health literacy to understand and pictograms may facilitate use of these plans. We aim to assess the feasibility of incorporating a pictorial asthma action plan for adults with asthma that is adapted to support self-management in Malaysia.

Methods: The study was conducted in a public primary care clinic using a mixed-methods feasibility study. We recruited patients aged 18 years and above with physician-diagnosed asthma and on inhaled corticosteroids. Participants were provided with a PAAP as part of their supported self-management. The primary outcome was asthma control (Global Initiative for Asthma symptom control). Participants were followed-up at 1, 3 and 6 months. A repeated measures analysis was conducted across four time points. Ethical approval was obtained from the Medical Research and Ethics Committee, Ministry of Health, Malaysia [NMRR-18-2683-43494].

Results: The 6-month preliminary analysis showed the retention rates were 90%, 87.1% and 84.3% at 1-, 3- and 6-month follow ups, respectively. At baseline, the majority of the 70 participants were 40 years and above (72.9%), had limited health literacy (61.4%), did not have a prior asthma action plan (60%) and had poor asthma control (65.7%). The effect of the pictorial asthma action plan only begins to be evidenced after 3 (OR=0.43; 95%CI=0.19 – 0.98; p=0.045) and 6 (OR=0.31; 95%CI=0.14 – 0.72; p=0.006) months.

Conclusion: The pictorial asthma action plan is a feasible tool to be used in supported self-management of adults with asthma.