Understanding what helps or hinders asthma action plan use: A systematic review and synthesis of the qualitative literature

Objective: To understand better what helps and/or hinders asthma action plan use from the professionals and patients/carers perspective. Methods: Systematic review and qualitative synthesis (using meta-ethnography). Results: Nineteen studies (20 papers) were included in an analysis of patients/carers' and professionals' views. Seven main influences on action plan implementation were identified including perceived un-helpfulness and irrelevance of the plans. Translation and synthesis of the original authors' interpretations suggested that action plan promotion and use was influenced by professional and patient/carers' asthma beliefs and attitudes and patient/carer experiences of managing asthma. Action plan use is hindered because professionals and patients/carers have different explanatory models of asthma, its management and their respective roles in the management process. Patients/carers, based on their experiential knowledge of their condition, perceive themselves as capable, effective in managing their asthma, but health professionals do not always share this view. Conclusion: Professionally provided medically focused action plans that do not 'fit' with and incorporate the patients'/carers' views of asthma, and their management strategies, will continue to be under-utilised. Practice implications: Professionals need to develop a more patient-centred, partnership-based, approach to the joint development and review of action plans, recognising the experiential asthma knowledge of patients/carers. © 2011 Elsevier Ireland Ltd.