Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review

Pulm Ther https://doi.org/10.1007/s41030-023-00218-y REVIEW Engaging Ethnically Diverse Populations in SelfManagement Interventions for Chronic Respiratory Diseases: A Narrative Review Stacy Maddocks . Pat Camp . Clarice Tang Received: November 27, 2022 / Accepted: January 30, 2023 Ó The Author(s) 2023 ABSTRACT The burden of chronic respiratory diseases continues to rise globally. Comprehensive management relies on a combination of treatment approaches including patient self-management, where health professionals are required to educate and support patients to take control of their disease. When self-management interventions are suitably directed and effec- S. Maddocks Department of Physical Therapy, University of British Columbia, Vancouver, Canada S. Maddocks
P. Camp Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada S. Maddocks
P. Camp Physiotherapy University of KwaZulu-Natal, Durban, South Africa C. Tang (&) School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia e-mail: C. Tang Allied Health, South Western Sydney Local Health District, Sydney, Australia tively executed, outcomes point to increases in quality of life and a reduction in unscheduled or emergency consultations for people living with chronic respiratory disease. However, despite these positive gains, the literature reveals poor trends of engagement with this management approach and reduced access to appropriately designed programs for people from ethnically diverse populations, including migrants and refugees. The purpose of this review article is to discuss factors influencing engagement in chronic respiratory disease self-management among people from ethnically diverse backgrounds and to propose strategies to improve the participation of this population in these interventions in the future. Keywords: Culturally and linguistically diverse; Ethnic minority; Chronic respiratory disease; Self-management; Cultural competence Pulm Ther Key Summary Points Ethnically diverse migrant populations living outside of their country of birth make up a substantial proportion of people living with chronic respiratory disease globally. Engagement in self-management interventions for chronic respiratory disease is poor, particularly in nonEnglishspeaking ethnic minorities. Barriers to engagement in selfmanagement include patient factors such as language and culture, health and socioeconomic status, along with health system factors, including the attitudes and cultural competencies of health professionals toward ethnic minorities and its influence on patient health literacy. To improve the engagement of ethnically diverse populations in chronic respiratory disease self-management, health professionals need to improve access to appropriately designed interventions through the personalization of program content and foster patient commitment through a robust health professionalpatient alliance. INTRODUCTION Chronic respiratory disease (CRD) is one of the leading causes of death and disability in the world and includes people across all cultural and ethnic profiles [1]. Self-management, a crucial component of managing CRDs, is dependent on a robust partnership between patients and health professionals, and demonstrates positive outcomes in healthcare utilization, respiratory symptoms, and quality of life [2, 3]. However, despite the reported benefits of CRD self-management, patient engagement in this intervention is generally low [4]. Barriers to engagement in self-management strategies have been widely described in the literature [4–6] and include the lack of belief in program effect and poor access to programs [7]. People from diverse communities, particularly from nonEnglishspeaking backgrounds, make up a sizeable proportion of people living with CRDs worldwide [8], yet they are often excluded in the literature. In this review article, we discuss the factors that influence engagement in self-management interventions among people with CRD and explore the additional challenges to participation in these interventions faced by people from diverse populations. Finally, we will discuss how to improve engagement with diverse populations in pulmonary-related self-management strategies. This article is based on previous studies and contains no studies with human participants or animals performed by any authors. EVIDENCE FOR SELFMANAGEMENT AND CRD Self-management interventions are a crucial component of the care continuum for people living with CRD, where healthcare professionals educate patients to improve their skills and confidence to manage their disease [9]. Common self-management interventions include education on self-recognition and treatment of disease exacerbations, smoking cessation activities, and pulmonary rehabilitation programs where both exercise prescription and advice about managing the symptoms of the disease are provided [10–12]. Reduced hospital admissions, improvements in self-efficacy to manage the disease, and increased health-related quality of life (HRQoL) are some of the reported benefits of CRD self-management interventions [3, 13, 14]. These findings were supported by an umbrella review that examined the effectiveness and efficacy of self-management interventions in asthma patients across 27 systematic reviews [15]. The review found that self-management interventions were associated with a decline in hospital admissions and an increase in HRQoL. Pulm Ther Furthermore, self-management programs have also shown positive effects on psychological status, which is a salient outcome for people with CRD who often experience anxiety and depression associated with disease-related activity limitations [4, 6, 16]. Although the literature highlights that self-management interventions are advantageous for improvements in HRQoL and patient control of the disease, engaging people in these interventions is a challenge [17, 18]. FACTORS INFLUENCING ENGAGEMENT IN SELFMANAGEMENT INTERVENTIONS FOR PEOPLE WITH CRD Patient and health system barriers to self-management in people with CRDs have been widely explored in the literature [4–6, 19] (see Fig. 1). Fig. 1 Factors influencing self-management among patients with CRD. In the Venn diagram, the left circle represents patient factors, while the right circle represents Figure 1 represents some recurring factors in the literature influencing self-management among patients with CRD. Patients’ personal contextual factors such as language and cultural background, illness perceptions, socioeconomic status, and health status may influence their attainment of the health literacy required to engage in self-management [4–6, 19–23]. Therefore, health professionals must demonstrate prudence in the approach to self-management recommendations by integrating the socio–cultural patient context with the biomedical management of their CRD profiles [20]. An exclusively biomedical approach to c (...truncated)