Perspectives and experiences of consumers and bicultural health educators on the diagnosis and management of asthma

Purpose Lack of access to culture-specific asthma care contributes to poor asthma outcomes in Culturally and Linguistically Diverse communities. A nurse-led asthma education programme incorporating Bicultural Health Educators to improve asthma outcomes was trialled in three of the communities most severely affected during a thunderstorm asthma event in West Melbourne, Victoria, Australia. This study aimed to uncover unique asthma management challenges affecting these communities. Patients and Methods A total of 47 participants with asthma from Vietnamese, Sri Lankan, and Indian communities completed two asthma education sessions, six weeks apart, with an Asthma Nurse Educator supported by a Bicultural Health Educator. At the first session the participants participated in a questionnaire and a narrative interview in which they shared their views on their asthma healthcare journey. Bicultural Health Educators recorded responses to open questions about perspectives and experiences of their journey, which were coded and thematically analysed.

Key factors impacting on asthma management from the consumer and Bicultural Health Educator perspective included limited knowledge of asthma, limited understanding of asthma management, difficulties with inhaler technique and difficulty navigating asthma care in the community. Culturally-driven attitudes towards asthma management, along with low educational literacy levels in some consumers also played a significant role.

The study identified factors impacting on asthma management in the Sri Lankan, Indian and Vietnamese communities in West Melbourne. Incorporating these insights into the delivery asthma care and education might improve asthma outcomes in these populations. Competing Interest Statement The authors have declared no competing interest. Funding Statement Grant Support provided by Asthma Australia Foundation and Western Health Chronic Disease Alliance Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Westen Health Low-Risk Ethics Committee (LNR/22/WH83847). Participants provided informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors - Abbreviations - BHE - Bicultural Health Educator. A BHE for the purpose of this study is defined as an individual from the studied communities, who has high levels of health literacy and can represent their community and culture through lived experience. - CALD - Culturally and Linguistically Diverse - GP - General Practitioner - Participant - patient or consumer