Exploring patient and carer perspectives on asthma self-management: a qualitative study from the IMP2ART programme

Background: Supported self-management reduces unscheduled care and improves asthma control, but only a quarter of people with asthma in the UK have a supported action plan Aim: To explore how patients/carers learn to manage their asthma, and their perspectives on the support they need for successful self-management. Methods: We purposefully sampled patients and carers (based on age, gender, experience of asthma) from 10 UK general practices to participate in focus groups or interviews. The topic guide addressed how their strategies for managing asthma evolved, their experiences of healthcare and views on supported self-management. Interviews and focus groups were audio-taped, transcribed and coded in NVivo. Analysis was iterative and interpreted in discussion with the IMP2ART team. Results: 49 participants (14 male) contributed 32 interviews and 5 focus groups. Individuals considered themselves responsible for looking after their asthma and most reported learning intuitively how to self-manage over years. Some frequently repeated behaviours become habitual. In contrast, dealing with new or uncommon situations (e.g. a deterioration in asthma control) required reflective abilities that could be put into action when needed. Patient centred care was highly valued; accordingly, many were disappointed with their perceived ‘tick box’ routine asthma review. Conclusions: Patients learn how to self-manage over time; building knowledge empirically, developing habits and learning skills to deal with new situations. Implementing optimal asthma self-management requires flexible practice routines that can synchronise with patients’ strategies. Funding: NIHR: RP-DG-1213-10008