Could a behaviour change intervention be used to address under-recognition of work-related asthma in primary care? A systematic review

Background Work-related asthma (WRA) is prevalent yet under-recognized in UK primary care.

Aim We aimed to identify behaviour change interventions (BCI) intended for use in primary care to identify WRA, or any other chronic disease (that could be adapted for use in WRA).

Design & setting Systematic review

Method We searched CCRCT, Embase, PsychINFO and Ovid-MEDLINE databases (1946-2023) for studies describing development and/or evaluation of BCIs for case finding any chronic disease in primary care settings, aimed at either healthcare professionals and/or patients. Two blinded, independent reviewers screened abstracts and assessed full text articles. We undertook narrative synthesis for outcomes of usability and effectiveness, and for BCI development processes.

Results We included 14 studies from n=768 retrieved citations, comprising 3 randomised control trials, 1 uncontrolled experimental study, and 10 studies employing recognized multi-step BC methodologies. None of the studies were concerned with identification of asthma. BCIs had been developed for facilitating screening programmes (5), implementing guidelines (3) and individual case finding (6). Five studies measured effectiveness, in terms of screening adherence rates, pre-/post-intervention competency, satisfaction and usability, for clinicians, though none measured diagnostic rates.

Conclusion No single or multi-component BCIs has been developed specifically to aid identification of asthma or WRA, though other chronic diseases have been targeted. Development has used BC methodologies that involved gathering data from a range of sources, and developing content specific to defined at-risk populations, so are not immediately transferable. Such methodologies could be used similarly to develop a primary acre-based BCI for WRA.