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PUBH6012 Programs to Create Awareness on the Self-Management of Asthma in Australia Assessment 1 Answer

ASSESSMENT BRIEF
Subject Code and TitlePUBH6012: Capstone B: Applied Research Project in Public Health
AssessmentAssessment 1: Report
Individual/GroupIndividual or Group
Length5,000 words
Learning OutcomesThis assessment addresses the following learning outcomes:
  1. Integrate and apply their knowledge and skills in public health
  2. Apply research skills to a public health issue
  3. Analyse the results of data collected from research, taking into consideration prior evidence and theory
  4. Understand the ethical implications for conducting a piece of public health research
6. Create a final research report
Weighting80%
Total Marks100 marks

Context:

This assessment advanced skills in reporting the justification, methods, results, and conclusions of a research project. Key understanding contained includes how to justify a research project using literature, how to implement a research proposal to collect and analyse data, how to report the results of the analysis of data, how to contextualise one’s own research in the context of the wider body of literature, and how to draw conclusions about future research and recommendations based on research. This prepares students for the conduct and reporting of research, which is an important skill set for public health practitioners.

Instructions:

Based on the feedback from your Capstone A Research Proposal, revise your research plan and GANTT chart.

Part 2:

The final assignment for this subject will be the write-up of the findings of your research into a final report. This will be comprised of the following parts:

  1. Abstract
    1. Summary of your report (as you would find in a published research article)
  2. Introduction
    1. Introduction to and justification of the topic area, drawing upon your literature review (from Capstone A), and including the knowledge gap your project addresses
    2. Your research question
  3. Research design and methods
    1. Summarise your research design/methods (from Capstone A)  what type of project did you do?
    2. How did you collect the data (ie search strategy and process/ policy consultation process)? If a policy consultation, explain how any organizations/individuals that you consulted with were approached
    3. How did you analyse the data (ie thematic analysis, systematic review process, consultation synthesis)?
    4. Briefly explain the ethical issues that should be considered
  4. Results
    1. Report the results of your findings, e.g. key themes if a qualitative study, results in table format if a quantitative study
    2. Clearly explain key figures, tables and graphs
  5. Discussion: Interpretation and contextualisation of your results
    1. Place your results in the context of your literature review
    2. Contextualise the results within the academic literature
    3. Describe any limitations of your study
  6. Conclusion
    1. Conclusions from this study
    2. Recommendations for future research or policy change based on feasible solutions
  7. Supplementary material
    1. Reference List
    2. Any appendices

This research report format has been based on the standard format for a journal article, and thus may be submitted to a journal in the future if the student is interested.

Assessment Criteria:

  • Revised and approved project plan and GANTT chart (5%)
  • Clear executive summary/abstract which condenses the findings of the report (10%)
  • Clear justification and outline of the significance of the topic (5%)
  • Justification of the research design and methods, including ethical considerations (10%)
  • Clear presentation of results, with transparency of findings (20%)
  • Comprehensive discussion of the results within the context of previous studies/theory, and identification of the limitations of the study, with recommendations for future research (30%)
  • Conclusion with logical recommendations related to the findings and wider literature (10%)
  • General assessment criteria (10%):
    • Provides a lucid introduction
    • Shows a sophisticated understanding of the key issues
    • Shows ability to interpret relevant information and literature in relation to chosen topic
    • Demonstrates a capacity to explain and apply relevant concepts
    • Shows evidence of reading beyond the required readings
    • Justifies any conclusions reached with well-formed arguments and not merely assertions
    • Provides a conclusion or summary
    • Correctly uses academic writing, presentation and grammar:
    • Complies with academic standards of legibility, referencing and bibliographical details (including reference list)
    • Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction
    • Uses appropriate APA style for citing and referencing research

Answer

Effectiveness of Health Promotion Programs to Create Awareness on the Self-Management of Asthma in Australia

Abstract

Asthma is a prevalent respiratory disease which accounts for high mortality rate. Self-management of Asthma is a vital step in coping up with the illness. This article is about the effectiveness of health programs in self- management of Asthma in Australia. The significant aspects, like various programs, challenges faced, and practices to improve the health programs, are discussed. The results obtained depicts that education is the key to managing Asthma, and there are various challenges in this way. Challenges like literacy, the role of health-care and proper material for educating is lacking. Thus different practices like targeted approach, skilled workforce and better educational aids can account for effective health programs. 

Background

Asthma is one of the most leading non- communicable diseases which has effected up the quality of life. Worldwide, Asthma holds 16th position in leading cause of disability among people. Approx 300 millions of people have Asthma, and it has been estimated that later 100 million may get sick. As per its prevalence, mortality, severity, there is a subtle geographically variation (Dharmage et al., 2019). However, mortality due to Asthma is higher in countries having low- middle income and high-income countries have a higher prevalence of this disease (To et al., 2012). National Asthma Council, Australia states that asthma prevalence is highest in Australia, and it is essential to have updated guideline (National Asthma Council, 2019).  

As per Global Initiative for Asthma, it is defined as a heterogeneous respiratory disease having characteristics of chronic inflammation in the respiratory tract and may get worse as time and intensity progress (Global strategy for asthma management and prevention, 2019).  Based on the comparison of epidemiological features such as chronic effect, environmental factors, disease trends between adults and children reflects that children have higher prevalence and incidence. In contrast, adults show a higher mortality and morbidity rate (Baiardini et al., 2015). Moreover, in adults, Asthma is more prevalent in women, whereas boys are more common in childhood asthma (Dharmage et al., 2019).  

Prevention of exacerbations, monitoring and controlling of the symptoms is a crucial step and is called as asthma management. The purpose is to reduce the chances of emergency treatment and to acquire long term control. Quality of life can be affected if the condition remains untreated with the diagnosed or undiagnosed disease (Joe et al., 2009). Hence for better treatment of asthma education of self -management is a vital tool. Knowledge about Asthma covers the preventive measures, treatment methodologies and also the mechanism of disease progress (McArthur, 2012).

In Australia, government and health professionals are working in collaboration to reinforce education among people by self-management education program (Dinh et al., 2016). It is well stated that self- management of Asthma improves life quality and also reduces the utilization of health care ( McArthur, 2012). 

Despite tremendous efforts, there is a huge gap due to lack of knowledge related to the disease condition and educational barrier (Clatworthy et al., 2009). Failure in the combination of human behaviour process and motivation to introduce educational program results into the malfunction of the management of chronic disease (Zafari et al., 2018). 

In Framework to this, consequently, this study is based on the effectiveness of the self-management program and commitment and support of Australia government so that productive self-management behaviour can be practice.

There is a necessity of proper action plan and programs for educating people about the preventive methods, self-management, medication and medical aid during emergencies. Targeted and precise health promotion programs are a must in Australia, which will immensely change the picture of Asthma care. Henceforth, the study would emphasize on understanding the various government policies, health promotion programs for self-management, multiple challenges and practices which might help in improving the health promotion programs. In the context of the selected topic, the research questions are:

  • How do educational health promotional activities create awareness of self-management activities to treat Asthma?
  • What are the challenges faced by the Australian population to incorporate self-management techniques?
  • What are practices that can be recommended to improve the health promotional initiative for self-management techniques?

Methods

The methodology of this study is based on investigating the pieces of evidence and available literature related to the role of education in self-management of Asthma. The course has also considered various health policies and their application in health programs.

Document Analysis

Document Analysis is an imperative aspect of any research study. In this study, various government health policies and supporting literature is critically analyzed. The health policies are looked insightfully for practices and recommendations for self-management of Asthma and the role of education in self-management. Several studies have emphasized the need for education in self-management and the requirement of more appropriate health program. The document analysis depicts the gravity of the issue and highlights on the market for various interventions.

Selection of Policy

The selection of policies was conducted on the criteria of self-management and ensuring that they focus on health programs for managing Asthma. The policies were selected only after assessing that they focus on self-management of Asthma, the importance of education in management, various health programs for Asthma and recommendation to improve the effectiveness of health programs. A second important consideration for the selection of the policy was that the source of the system is credible. The document of the selected policies is readily available and is cited in the various website, journals or publications. After considering all these aspects, policies were reviewed insightfully and were then finalized for the study.

The following abbreviations will be taken into considering for the selected research topic: The Asthma Australia’s(AA), National Asthma strategy (NAS), National Asthma Council (NAC), Australian Institute of Health and Welfare (AIHW), Respiratory Disease Service Improvement Framework (CSIF), Asthma and Smoking Prevention Project (ASPP), Northern Territory (NT), Adolescent Asthma Action (Triple-A) program, Better Outcomes for Lung Disease (BOLD) project, Asthma Control Test (ACT). 

Asthma Australia’s(AA), Asthma Child and Adolescent Program
2019
National Asthma Council (NAC)
2001
The Asthma policy( HDKA)
2012
Asthma model of care
2012
National Asthma Strategy (NAS)
2018
The Asthma policy (stable kindergarten)
2019

Coding Framework for Analysis of Documents

A research team designed the Framework of the coding after reviewing the polices and other relevant literature. The Framework was structured to attain a broader perspective in the study.  The Framework was categorized into three categories, and these categories were further subdivided. These categories or codes were designed after reviewing the available policies, literature and health programs. The journal articles, books, publications and policies considered were related to self-management of Asthma (Sridhara&Shanbhag, 2005). An insight into the issue was gained after reviewing available literature, and then the codes were designed by the research team. Australian policies and publications were preferred to attain more specific knowledge. The developing of principles was inspired by the scholarly works of the authors emphasizing on self-management of Asthma and importance of health programs. The researcher designed the structure of coding after agreeing with the research team during the data accumulation and analysis.

Main Category 
Preliminary codes 
Role of educational programs in self-management 
Use of inhaler appropriately, Triggers of Asthma, Various health programs like COACH, mobile apps etc.
Challenges in self-management  
Health literacy, Unavailability of resources in remote areas, Aboriginal and Torres islander chronic condition of Asthma, Lack of skilled workers, Limited funds.
Practices to improve the effectiveness of health promotional programs
We are improving literacy related to asthma health, health workforce plan, Targeted programs, better educational aids, Training for the non-medical professional, a collaboration between various health-care organizations.

Coding

Three principal codes were selected and were subdivided further more into several codes. The policies and available literature were analyzed to create a narrative for each of the code. The result and findings foe each code was developed after researching above mentioned the policies. Each of the policy was analyzed with the view of self-management of Asthma and the role of educational programs in asthma management. The Management of Asthma is designed with the perspective of (CSIF Standards 3-9), which states about integrated and coordinated services for consumer education and state-wide referral pathways. The considered policies have discussed self-management in light of CSIF Standard 3. Thus while designing the codes, this universally accessible standard for support and self-management of Asthma was considered.

The principal codes selected for the topic area) Role of educational programs in self-management b) Challenges in self-management c) Practices to improve the effectiveness of health promotional programs.

Results

This section of the report will delineate the findings of the thematic analysis by reviewing key codes in regards to the selected topic. The main themes are as follows: 

Role of Educational Programs in Self-Management

The primary purpose of the health education activities is to increase knowledge, the achievement of good habits and new behaviour for the health improvement of the populations (Brasil et al., 2012). These are the ways through which a person can gain systemic awareness and knowledge about health. By providing health education against following causative factors, asthma self-management activities can be promoted:

  • Use of inhaler appropriately: along with the avoidance of trigger factors of asthma patient is using inhalers as a preventive and treatment for the Asthma. By the use of an inhaler, medicine can be directly delivered to the airway, and by the correct use of it, symptoms can be relieved and treated. Hence, for the effectiveness of the therapy educating about the appropriate use of inhaler is essential (Hussain&Paravattil, 2020).). 
  • Triggers of Asthma:  it is essential to know both intrinsic and extrinsic stimuli through which asthma attack can arise. In the asthma self-management knowledge about motivations and its avoidance is imparted (GINA, 2017).  Some of the critical points of self-management programs about triggers are
  • Smoking:Education about the ill effect of smoking is essential for asthma patients. Generally, asthma patients quit active smoking, but they are not aware of the side effects of passive smoking. Thus, knowledge about the ill effects of active and passive smoking and its management is necessary for asthma patients (Shimoda et al.,2016). Therefore patients should know to self-manage the regimens of smoking cessation so that health can be promoted. 
  • Exercise:  physical exercises have good result upon health, but a moderate exercise in Asthma may induce asthma attack for which medication is needed to relieve symptoms. So a person should have an education that which drug has to be taken before the exercise so that exercise-induced Asthma can be prevented (GINA,2017).  
  • The thermal stress can increase environmental factors: occurrence of allergic and respiratory conditions over the body (Farrell et al.,2008).  Some of the elements are-
  • Pillow: feather filled pillow and bedding are more likely to have gathered allergens than the artificial fibre-filled and bedding. Therefore, such programs impart knowledge about the use of allergens impermeable pillow and mattress as well so that dust mite allergens can be prevented (National Asthma Council Australia,2002). 
  • Pets and mites:The programs are aimed to teach patients about possible ill effects of keeping pets as one of the major causes of Asthma is dogs and cats. (Matsui et al., 2016). Along with it, educational programs teach patients how dust mites and humidity in homes can be controlled. Thus, making people aware of keeping their surroundings clean, dust-free and avoid humidity (Gabbay& le, 2004).
  • Common cold and flu:  any kind of infection in nose and throat like cold and flu can be the trigger factor of Asthma. It is essential to know the sign and symptoms of the same so that early prevention can be done (GINA, 2017). 
  • Stress: one of the physiological factors of causing asthma trigger is stress, so by controlling stress disease management can be improved and also the severity of symptoms can be prevented (Murray et al.,2018).  

Overall above-mentioned health educations aspects are supported by several international education patterns to enhance self-care and self-management, which reflects that Australia considers self-care as a core element of health policy (National Asthma Council Australia,2002). In the management of the chronic asthma condition, management plan serves as an essential tool. Altogether these measures have the possibility of reducing asthma management cost.

There are various programs which support asthma self-care such as integrated chronic disease care models development, supportive peer initiative, and consumer-directed information. The programs are aimed for people who are at significant risk of health and focuses in people engagement so that deficit knowledge of health, guidance for decision making can be improved For the encouragement of the asthma actions plan, Australia has many health programs, general practice on asthma reviews and asthma clinics. It has been found that 30-40% of the patient attended asthma education session (National Asthma Council Australia, 2002). Three visits found to be unrealistic due to which former asthma three-plus visit plan in a general practice located in Australia (Zwaret al., 2005).

Some of the successful programs run in Australia are:

Asthma and Smoking Prevention Project (ASPP) is an education program for young Aboriginal and Torres Strait Islander people in the Northern Territory (NT). It is designed to improve self-management in Asthma and prevent smoking. This program is a part of the Adolescent Asthma Action (Triple-A) program.  The plan was quite beneficial for the students in Northern Territory schools.  

The Australian Government also runs various other successful programs. The Better Outcomes for Lung Disease (BOLD) project was conducted by Asthma Foundation NT, Bodyfit NT and Wisemind Psychology Pty Ltd. It aimed at self-management for people with chronic obstructive pulmonary disease and/or Asthma. The program was of 12 weeks, provided exercise and education sessions.  Radio program, Health matters and staying healthy, were designed for Aboriginal people in Western Australia (Asthma Australia, 2019). Another important program is COACH program which is developed by Asthma Australia to impart coaching and educational support to the people over the phone. The coaches are skilled health-care professionals. In one year, the Over the average Asthma Control Test (ACT) score was improved from 9.9 to 20.9, indicating well-controlled Asthma. A program name sensitive choice was started in 2006, by the National Asthma Council of Australia. It was a successful initiative and was later extended to New Zealand. It has 65 partners globally and trademarked in 63 countries. Recently mobile apps like Kiss My Asthma are also promoted. These apps are targeted for a young population ranging from 12-24 years.

Asthma Australia states that 61.6% of people accessing community support program improved their asthma score by five or more points. Thus, the Australian Government is focusing on self-management by commencing various health programs covering different aspects of self-management. Yet, there are multiple challenges which should be overcome.The proportion of people with Asthma plan, by age group, 2017-2018

Figure 1:  figure depicting the details of the COACH program

(Source: Asthma Australia, 2019)The proportion of people with Asthma plan, by age group, 2017-2018

Figure 2: The proportion of people with Asthma plan, by age group, 2017-2018

(Source: ABS, 2019)

Challenges in Health Programs for Self-Management  

While supporting the self-management, there are several challenges which has to be overcome such as

Health Literacy and Unavailability of Resources in Remote Areas: Low skills of literacy are one of the reasons behind difficulty in adherence towards the particular management plans (Seibert et al.,2019). Low literacy, especially in rural communities is a significant hindrance in controlling symptoms; thus, health professionals have to provide additional support to make people understand about self-care plans.

However, Alfred Health in Melbourne revealed a data which suggested that 13% of the patient for challenging to treat Asthma shown progress from general clinics of respiratory after receiving subspecialized services  (Tzeng et al., 2017). People with ethnic minorities, along with intellectual disabilities, have a fear of medication use because of their side effect and shows avoidance behaviour towards a treatment plan. Other medication barriers include lack of medical knowledge, cost of medicine, and inconvenience in medicine intake. However, these barriers can be overcome by incorporating confidence about asthma self-care with the collaboration of work with health care practitioner. Other professional and organizational factors like time limit of consultation, level of teamwork etc. also act as challenges.   

 Among the population of Aboriginal and Torres islander, chronic condition of Asthma is over presented. About 58% of the age group 15-24 years and 33% of children between 0-14 years age group were found to be more affected. Extra importance has to be carried for Aboriginal and Torres children for identifying and effectively addressing Asthma. Comparative to the non-indigenous population poor health condition, premature deliveries and mortality rate are found significantly high among the indigenous people (Australian Bureau of Statistics, 2013; AIHW 2016). Graph showing the indigenous and non-indigenous population affected by Asthma

Figure 3: Graph showing the indigenous and non-indigenous population affected by Asthma

(Source: Asthma Australia)

Limited Funds:Health care and research work always require funds.In spite of thisfund reduction by the Australian Government has been observed by $31.9 million in the year 2017-2018, 57.8 million in 2018- 2019 and the year 2019-2020 fund was $92.4 million.  To fund health-related policies as a priority, the Australia government were said to redirect these reduce funds. Asthma Australia was getting funds as a priority of national health though, in the last three years, total $4.73 million have been reduced from the organizations (AIHW, 2016). 

Deficit Skilled Health Practitioner: The health care workers are not adequately skilled. They lack thorough knowledge about the self-management of Asthma. Hence, they are incapable of educating patients efficiently.  Even general health practitioners are implementing available care rather than the required specific asthma care. It is also observed that health care workers are not following the proper guidelines mentioned in government policies. A Difference has been evaluated in between written asthma guidelines and practices (Hanlon et al., 2017).  

Practices to Promote Health Promotional Programs 

Effective self-management practices empower the asthma people by increasing knowledge, skills and confidence so that they can participate in improving their health (National Asthma Council Australia, 2016). There are many practices that can be recommended:

Targeted Approach: The targeted approach is imperative for the success of any promotional activity. The health promotion program for self-management of Asthma must be targeted according to the community, population or age. A standard schedule for all could not be a useful tool. For example, Asthma Australia runs a program named Asthma Australia's Asthma Child and Adolescent Program. This program is aimed to render training to schools staff for supporting self-management for adolescents. More such programs are needed because educating at an early age can be immensely helpful in this fight against Asthma.

Fund Requirement: The increase in government funding can immensely help in promoting health programs. Increased funds can help in approaching people in remote areas, for the collaborative performance and the counselling and coordination. In 2018, The Australian Government provided the fund of approximately $8 million to support asthma treatment by investing in various health programs. $7.6 million was donated to Asthma Australia for to training programs (Department of Health, 2018)

Literacy Improvement at the Early Age: This action can be a significant step and can be implemented by educating about the disease in the schools. The Australian Government should provide formulation and implementation of National best health practices guidelines for school. Training should be provided to the teachers about self-monitoring of health status. In this collaboration with the health industries members can also be done. Protocol for first aid implementation can also be included so that early prevention can be done. A combination of behaviour therapy and education about asthma self-management is found to be more efficient. The purpose of the self-management of the asthma symptoms can be supported by the technique of behaviour change (Mammen et al., 2018).   The asthma policies for stable kinder garden and Harsham and district kindergarten association (HDKA), highlights the need for education at an early age (HDKA,2012; Stable Kindergarten, 2019) Data demonstrating the percentage population with adherence to medication

Figure 4: Data demonstrating the percentage population with adherence to medication

(Source: AIHW 2015)Data depicting percentage population using the inhaler correctly

Figure 5: Data depicting percentage population using the inhaler correctly

(Source: AIHW, 2015)

Organizing Different campaigns: Health campaigns must be organized significantly for the asthma patients, carers and for the rural community like aboriginal population; who are at a greater risk of Asthma. The campaign should address preventive medicines, trigger factors; myth, misperception, advance technologies, government policies, asthma self-management practices etc. should be implemented. 

Implementation of Health Work Force Plan for Skilled Personnel: the Australian Government should support asthma primary health care and hospital referral program like COACH. Under this support, personal coaching support for asthma management can be provided. It should also focus upon the multidisciplinary care through which need base care can be available to the Australian people at the right time.  Under this status of care providers such as a physician, nurses, the pharmacist should be evaluated so that gap between the guidelines and practices can be assessed. For the enhancement of knowledge related to advance technologies like E-Health adaptation can be provided either online or face to face.

Collaborative Work with Health System: those who are non-hospital care providers like community worker, asthma educator should also be supported by the Government so that collaboratively with the other general health practitioner they can also provide place-based care like in the aboriginal community. Engagement between the Area Health Services and community pharmacy needs improvement. This lack of attention contributes to pharmacists acting in isolation primary care practitioners.

Discussion

Asthma is one of the most prevalent respiratory diseases which affects people of all age groups. However, the data demonstrate that the occurrence of Asthma depends upon varying factor like age, gender, lifestyle etc. (Australian Government, 2016). Quality of life of the patient and family members is adversely affected by uncontrolled Asthma. Because of an asthma attack, around 4.5 days per year work or school missed and approximately one day of school is missed by 50% of children who are diagnosed with Asthma (Helen et al. 2015). Comparatively to the high-income family low-income family are more prone to have diagnosed with asthma (American Academy of Allergy Asthma and Immunology, 2016). Poor access to health insurance, cultural beliefs related to medical care and health care providers are also found to be the cause of health problem aggravation (National Health Interview Survey, 2014).  

To prevent flares- up and symptoms of Asthma, good self- management practices are meant. Aspects which are focused under these practices are aimed to provide care to the person with Asthma so that patient can regulate themselves for their healthy behaviour and treatment. These self-management practices involve proper medication therapy, use of the appropriate technique for an inhaler, self-assessing of asthma symptoms and proper lungs function, implementation of the asthma action plan, prevention from triggers of Asthma, regular health check-ups etc. (National Asthma Council Australia, 2016) all the strategies which are recommended for the self-management not only benefit to the respective individual but also the community (Marks et al., 2000; National Asthma Council Australia, 2016). Improvement in the symptoms and declined hospital visit and hospitalization due to asthma management program has been observed. A study was conducted in 2016 to assess the effectiveness of a health program in the management of Asthma in children. Total of 304 children was screened. The results obtained demonstrated that a substantial decrease in asthma exacerbation was observed in patients who participated in the intervention (Guarnaccia et al., 2016). Thus it is evident that health promotion programs are immensely helpful. 

In another study with pregnant asthma patients, asthma self-management skills were assessed. Total of 211 and 149 patients were examined at 20 and 33 weeks gestation, respectively. At the first visit, 40% of females reported no adherence to inhaled corticosteroids. Among them, 42% had improper knowledge of medication, and only 15% had a written action plan. After the complete program, a significant change was observed in night symptoms and reliever medication (Murphy et al., 2005). Thus, it is well documented that education has an imperative role in self-management of Asthma. A study suggested that a brief education session among patients, general practitioners, and nurses show the effective use of devices, reduction in hospital admission and quality of improved life.

However many factors act as a barrier in people participation among such health programs such as poverty, transportation arrangement for the physician, language, need of health insurance etc. (McCleary et al., 2018; Krieger et al., 2005). The gap between priorities set by Australian general practitioners and current asthma guidelines is also can be the reason of asthma prevalence. Top identified priorities are patient education about self-care and medication, regular follow up, the treatment plan for asthma management, proper diagnose and treatment. Few of these priorities are also present in the guide plan but are not always considered by general practitioners (Abramson et al., 2001). It has been reported that for treatment of exacerbation general practitioners are not prioritizing condition as per documented in the asthma action plan (Ruffin et al., 2001; Douglass et al., 2002). For the support of Asthma, six-step asthma management plans are introduced, which is different than the written asthma action plan (National Asthma Council Australia, 2002).  

Treatment efficacy is challenging when guidelines are translated into clinical practices (Lenfant, 2003). Health care workers should approach with Patient-centric approach as per the model of chronic illness care (Gabbay& le, 2004; Mead  &Bower, 2000). To deal with the challenges, it is essential to focus on workforce service education program, so that they can have updated knowledge to educate patients (Lorig, 2002) and also physician therapeutic skills can be improved.

A prospective observational study was conducted to assess the effectiveness of this approach, and it has been found that international guidelines recommendations like multidimensional approach are effective in reducing exacerbations, improving quality of life and controlling asthma symptoms (Tay et al., 2017). For the attainment of the optimum health quality, it is recommended for optimal use of care plan meant for Asthma, adherence to the recommended guidelines for the maintenance therapy, referral services in severe cases and increased use of spirometry (Gibeon, 2015).  Despite urging all people with Asthma have an asthma action plan, many people with Asthma do not have a current written plan. In 2017–18, an estimated 839,000 (31%) people with Asthma across all ages had a written asthma action plan (National Asthma Council, Australia, 2019).

According to Marmot et al., 2008, social determinants of health can be reduced by investing in health education so that more excellent knowledge and awareness can be spread and also promotion of the ability among people can be enhanced by which they can make healthier choices for symptom control.

Apart from educating health workers and improving medical aids, it is also essential to focus on most affected groups like adolescents and some communities like Aboriginal and Torres Strait Islander. Intrapersonal and interpersonal factors influence self-management behaviour among adolescent. Intrapersonal factors like educational level, attitude, knowledge and belief, the burden of treatment etc. (Holley et al., 2017) and interpersonal factors such as communication with peers, family member and health care providers and also social relationship (Mammen et al., 2018). Thus, young people must be educated about Asthma by considering these points. This would immensely help in mitigating the disease at a very early stage. 

Prevalence of Asthma among Aboriginal and Torres Strait Islander is just twice of the cases in non- indigenous population; For controlling the asthma prevalence in indigenous people, it is essential to consider various inhibiting factors like frequent services to the workers, recognition of socioeconomic status, social factors ( housing, education, employment, food security and sanitation), disease co-morbidity and many more (Australian Government,2016)which impact over the provision of health service, reinforcement of health inequities.

Hence it is worth mentioning that various health programs are essential to spread awareness about self-management of Asthma.  The National Asthma Campaign (NAC) was started in 1990 to fight against Asthma and for its management in Australia (Comino et al., 1997). Since then, the Australian Government has come up with several programs and improved policies. Asthma action plans have formed part of the National Asthma Council Australia's guidelines for the management of Asthma for 30 years. They have been promoted in public education campaigns. For the encouragement of Asthma, actions plan Australia has many health programs, general practice on asthma reviews and asthma clinics (Zahradnik A,2011). It has been found that 30-40% of the patient attended asthma education session. Three visits found to be unrealistic due to which former asthma three-plus visit plan in general practice was found in Australia.

As a critical component of optimal asthma management, National Heart, Lung and Blood Institute developed clinical practice guidelines (Hsu et al., 2018). Moreover, a new technical package purpose of improving asthma control, EXHALE is introduced which highlighted the importance of Asthma self-management education and also a publication of AS-ME national standards is done (McCleary et al., 2018).  A variety of information and skills is provided in this AS-ME such as how airway functions, use of multiple medications, lungs physiology, warning signs and clinical symptoms and many more. For the families education concern it includes information about environmental trigger factors roles and how the exposure in irritant and allergens can be prevented (Hanlon et al., 2017).   

The Government is focusing on the importance of health education in the treatment of Asthma. With the advancement of technology, social media, apps and other aids are used to educate people. The improvised action plans are developed, which should reach to the patients. Thus, it is worth noticing that despite tremendous efforts, there are still some challenges which need to be met.

Conclusion

While concluding, it could be stated that Asthma is one of the most chronic respiratory condition, which is affecting the Australian population to a broader extent. The quality -of- the life of patients and family members significantly reduces due to the asthma condition. The burden of Asthma can be reduced in which patients and families play a substantial role by reducing exposure to environmental triggers, quick respond to exacerbation and through medical management (MC cleary et al., 2018). It is essential to have adequate training and education so that patients and caregiver can understand the trigger factors, path physiology of respiratory, medication affect a short term or long term and also about other rescue therapies.   

Limitations

Despite many unavoidable limitations, the researcher has reached its aim.  Time constraints affected the study that only focused upon self-care management practices among Australian people there are some other practices or guidelines also available which can also be explored and evaluated such as preventive drug role in asthma management. Furthermore, this study is subjected to different interpretation.

Recommendations

It is known that Asthma is one of the common childhood illnesses. In many of the studies, it has been reflected that self-management is to be beneficial. Through better health literacy and clinical guidance, patient's empowerment can be improved, which results in the decline morbidity rate. However, there are various factors which affect asthma-related programs, policies. Recommendations which have to be considered are as follows:

  • As part of the entire management of asthma patients, systemic pharmaceutical care delivery should be implemented to improve the health quality of people.
  • Review of standard treatment guideline must be implemented for ensuring patient adherence.
  • The Government should emphasize skilled health-care professionals so that they can account for the success of health programs by imparting proper education.
  • Education for asthma management should be imparted at an early age in schools. The programs should be more community targeted and customized as per the need of the particular population, community or age group.
  • Government fund should be raised so that health promotion aid and services can be promoted.
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