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Patients play a critical role in managing their long-term conditions. It seems obvious, but if they fully understand why it’s important to take their medication regularly and the benefits of doing so, they are more likely to successfully self-manage their condition. However, it’s paramount to recognise that we live in a multicultural society where English is not everyone’s first language. Only by developing culturally appropriate information, can you enable patients to take charge of their own care, helping them to lead healthier lives with better controlled symptoms.

This, in turn, will support primary care in managing patients’ conditions more effectively and relieve pressure on acute services by reducing the need for emergency care and more expensive treatment options.

Non-English-speaking communities and high levels of prescribing versus low levels of referrals

Utilising the Accelerated Access Collaborative (AAC) Pathway Transformation Fund, and working with me, Dr Llinos Jones, an asthma consultant at Mid Yorkshire Hospitals NHS Foundation Trust, recognised that some patients experienced barriers in accessing the severe asthma service that she set up in Dewsbury. In some cases, her patients were finding it difficult to adhere to their asthma medicine.

Using regional data, Dr Jones was able to analyse GP prescribing patterns and rates illustrating areas of over-prescribing of SABA asthma inhalers with low biologics referral rates, which indicated a potential problem in terms of optimised asthma management. Asthma biologics work in a targeted way, by disrupting pathways causing airways inflammation, helping to manage symptoms and reduce exacerbations. When Dr Jones overlapped these prescribing rates with areas of high ethnic diversity, and the percentage of non-English-speaking communities, the association was clear.

This analysis indicated that there was a need to further investigate these synergies and work with clinicians and community members to determine where improvements could be made. Interviews and focus groups conducted by the University of Huddersfield revealed key issues regarding cultural differences and barriers.

Patient and Public Engagement

Data collected from interviews and focus groups suggested that there was a variable level of knowledge about asthma care, with many myths and misconceptions circulating around the condition. This spurred Dr Jones to seek a solution to remove the root cause of these barriers. She states that “there is a wisdom within communities that needs to be harnessed, successful problem solving from within is essential, and can be impactful, and sustainable. With clear, relevant health management information, members would feel more engaged and empowered to manage their own conditions in a more effective way”.

What our communities are saying

Interviews from the South Asian community in Kirklees uncovered that language played an enormous role in community members not knowing where to access help for asthma, including what to do in an emergency situation. In some cases there were low levels of understanding when attending doctors’ appointments, how and when to take medications.

Community members also stated that they often felt excluded and under-represented in the health literature that is available to them. Much health literature did not visibly represent them, nor did they cover the culturally specific questions that they wished to ask.

Interviews and focus groups highlighted some key issues regarding cultural differences and barriers:

• Barriers perceived to be linked to stereotypes
• Misconceptions or denial about the condition
• Cultural determinants e.g. don’t bother the doctor, delay visit, only use emergency services when in serious need of help
• Misconceptions around what food you can eat
• Misconceptions around the causes and connotations of asthma
• Stigma of living with asthma (reluctance to seek help)
• Insufficient socio-cultural support
• Limited knowledge of the health care system and how to access the care they need

What next

A suite of multilingual, culturally competent resources was co-designed by the team alongside community members and the healthcare providers serving that population. These evaluated very positively and were spread widely. Grass roots spread of messages was also achieved by training community champions. By harnessing the authentic, trusted voices within the community, messages were well received.

Working in collaboration with NIHR Applied Research Collaboration (ARC) Yorkshire and Humber to assess the outcomes of this approach, the evaluation revealed a direct link between poor adherence and increased acute asthma episodes, which contributes to worse patient health and substantial costs to the NHS.

You can read more about the research conducted by the NIHR ARC Yorkshire & Humber in this article.

I hope that this research will help commissioners appreciate the importance of creating culturally appropriate health literature, a simple but effective approach. This is essential to ensure that patients use their asthma inhalers correctly, enabling them to effectively self-manage their condition.

Resources available to support patients self-manage their asthma

Guide to asthma self-management – YouTube

NHS ‘Guides to help you manage your asthma’ poster