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South Asians Respiratory and Inhaler Intervention (SARIs)

Leicester is known as a city of diversity, with 37% of its population identifying themselves as Asian or Asian British. Therefore it is crucial that attention is drawn towards the diverse group, and the issues they are likely to face in the health care system, including misunderstandings by health care professionals of their health care beliefs and the issues arising in communication due to language barriers.

Research has gone on to highlight how ethnic minorities are likely to experience poor care as well likely to poorly handle their respiratory disorder.  It has been suggested that a number of culturally specific factors might explain the unequal impact of ethnicity on health outcomes of respiratory related illness. International data suggests that there are disparities in the risk of hospitalisation linked to ethnicity (Nicole, Tran et al 2011). Cultural sensitivity is paramount in the understanding of asthma management. Health staff should give high priority to eliciting parents’ beliefs regarding the management of their children’s asthma (Smeeton, NC et al 2007).

The MIA study (Bird et al 2011) describes the important influence of family, friends and key figures in the management of asthma.  Deliberate interventions by family members include suggestions of alternative treatments or dietary restrictions. On the other hand, accidental interventions include expectations of restricted activities for children with asthma and in maintaining social stigma, all of which hinder effective concordance in management.  The evidence for the management of COPD in the South Asian minority ethnic population is limited.

Researchers

Dr Neena Lakhani
Senior Lecturer,
School of Pharmacy, 
Faculty of Health and Life Sciences,
De Montfort University;
T: +44 (0)116 207 8112
E: nlakhani@dmu.ac.uk

Dr Diane Wensley
Senior Lecturer,
School of Nursing and Midwifery,
Faculty of Health and Life Sciences,
De Montfort University,
T: +44 (0)116 201 2680,
E: dwensley@dmu.ac.uk

Dr Peter Rivers
Reader in Pharmacy Practice,                  
Faculty of Health and Life Sciences,
De Montfort University,               ,   
T: +44 (0)116 257 7039
E: privers@dmu.ac.uk

References

1.Office National Statistics (ONS) 4th March 2013- accessed 26th March 2013.

2. Tran HN, Siu S, Iribarren C, Udaltsova N, Klatsky AL.Nicole. Ethnicity and risk of hospitalization for asthma and chronic obstructive pulmonary disease. Ann Epidemiol 2011; 21:615-622.

3. Nigel C Smeeton, Roberto J Rona, Jane Gregory, Patrick White, Myfanwy Morgan. Parental attitudes towards the management of asthma in ethnic minorities. Arch Dis Childhood doi:10.1136/adc.2006.112037 accessed 25th March 2013

4. Bird D, Culley, L, Lakhanpaul, M (2011). The Influence Of Community Perceptions On The Management Of Childhood Asthma In South Asian Groups: Initial Data From The Management And Interventions For Asthma (MIA) Research Group. Am J Respir Crit Care Med 183: A1898

Research aims and objectives

The study aims to explore and identify issues and difficulties South Asians experience in regards to their respiratory health and inhaler use. The study also wishes to further explore how South Asians may seek help for these issues in the city of Leicester and the county of Leicestershire.

  1. Identify and clarify social and cultural issues associated with adherence to medication and help seeking behaviours used in South Asian patients with respiratory illness.
  2. Appraise the use of existing objective measures of disease control (e.g. ACQ questionnaire (Juniper E  http://www.qoltech.co.uk/index.htm ) and interventional tools such as SIMPLE (Murphy A) and develop these further to be more culturally sensitive for use in South Asian communities.
  3. Contribute to/ develop an evidence base (utilising theory of change) to inform the development of culturally sensitive community pharmacy services (health education packages) for South Asian service users with respiratory health problems.

Method

Phase 1- Two to four interactive focus groups will be organised in appropriate settings where stakeholders (e.g. members of minority communities, healthcare professionals and community leaders) discuss ‘respiratory’ pharmaceutical care needs and related cultural issues of service users.  
These will be held as focus groups within the relevant community groups which will be culturally specific.

Phase 2- A Delphi-style technique encompassing and including ‘Theory of Change’ (or alternative theory as agreed with the stakeholders from Phase 1).  Nominal group techniques will be applied with statements developed from themes identified by analysis of phase 1 focus group results.
Focus group of culturally relevant health professionals with an interest in respiratory health will be convened. Alongside group leaders from the South Asian Community who are influential key figures (Bird et al , 2011)

Phase 3- Implementation and evaluation of culturally competent pharmaceutical care service
A pilot service will be introduced to 5-10 community pharmacies within the DMU square mile area and or a ward where there is a high prevalence of members of the South Asian community.