Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/22371
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dc.contributor.authorRing, Nicola Aen_UK
dc.contributor.authorBooth, Hazelen_UK
dc.contributor.authorWilson, Carolineen_UK
dc.contributor.authorHoskins, Gayloren_UK
dc.contributor.authorPinnock, Hilaryen_UK
dc.contributor.authorSheikh, Azizen_UK
dc.contributor.authorJepson, Ruthen_UK
dc.date.accessioned2017-10-17T22:13:03Z-
dc.date.available2017-10-17T22:13:03Z-
dc.date.issued2015-10en_UK
dc.identifier.other145en_UK
dc.identifier.urihttp://hdl.handle.net/1893/22371-
dc.description.abstractBackground: Personal asthma action plans (PAAPs) have been guideline recommended for years, but consistently under-issued by health professionals and under-utilised by patients. Previous studies have investigated sub-optimal PAAP implementation but more insight is needed into barriers to their use from the perspective of professionals, patients and primary care teams.  Methods: A maximum variation sample of professional and patient participants were recruited from five demographically diverse general practices and another group of primary care professionals in one Scottish region. Interviews were digitally recorded and data thematically analysed using NVivo.  Results: Twenty-nine semi-structured interviews were conducted (11 adults with asthma, seven general practitioners, ten practice nurses, one hospital respiratory nurse). Three over-arching themes emerged: 1) patients generally do not value PAAPs, 2) professionals do not fully value PAAPs and, 3) multiple barriers reduce the value of PAAPs in primary care. Six patients had a PAAP but these were outdated, not reflecting their needs and not used. Patients reported not wanting or needing PAAPs, yet identified circumstances when these could be useful. Fifteen professionals had selectively issued PAAPs with eight having reviewed one. Many professionals did not value PAAPs as they did not see patients using these and lacked awareness of times when patients could have benefited from one. Multi-level compounding barriers emerged. Individual barriers included poor patient awareness and professionals not reinforcing PAAP use. Organisational barriers included professionals having difficulty accessing PAAP templates and fragmented processes including patients not being asked to bring PAAPs to their asthma appointments.  Conclusions: Primary care PAAP implementation is in a vicious cycle. Professionals infrequently review/update PAAPs with patients; patients with out-dated PAAPs do not value or use these; professionals observing patients’ lack of interest in PAAPs do not discuss these. Patients observing this do not refer to their plans and perceive them to be of little value in asthma self-management. Twenty-five years after PAAPs were first recommended, primary care practices are still not ready to support their implementation. Breaking this vicious cycle to create a healthcare context more conducive to PAAP implementation requires a whole systems approach with multi-faceted interventions addressing patient, professional and organisational barriers.en_UK
dc.language.isoenen_UK
dc.publisherBioMed Centralen_UK
dc.relationRing NA, Booth H, Wilson C, Hoskins G, Pinnock H, Sheikh A & Jepson R (2015) The 'vicious cycle' of personalised asthma action plan implementation in primary care: a qualitative study of patients and health professionals' views. BMC Family Practice, 16 (1), Art. No.: 145. https://doi.org/10.1186/s12875-015-0352-4en_UK
dc.rights© 2015 Ring et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_UK
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_UK
dc.subjectBarriersen_UK
dc.subjectImplementationen_UK
dc.subjectPersonalised asthma action plansen_UK
dc.subjectPrimary careen_UK
dc.subjectQualitativeen_UK
dc.subjectSelf-management plansen_UK
dc.titleThe 'vicious cycle' of personalised asthma action plan implementation in primary care: a qualitative study of patients and health professionals' viewsen_UK
dc.typeJournal Articleen_UK
dc.identifier.doi10.1186/s12875-015-0352-4en_UK
dc.identifier.pmid26487557en_UK
dc.citation.jtitleBMC Family Practiceen_UK
dc.citation.issn1471-2296en_UK
dc.citation.volume16en_UK
dc.citation.issue1en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.author.emailnicola.ring@stir.ac.uken_UK
dc.citation.date21/10/2015en_UK
dc.contributor.affiliationHealth Sciences Research - Stirling - LEGACYen_UK
dc.contributor.affiliationFaculty of Social Sciencesen_UK
dc.contributor.affiliationHealth Sciences Post Qual - Stirling - LEGACYen_UK
dc.contributor.affiliationNMAHPen_UK
dc.contributor.affiliationUniversity of Edinburghen_UK
dc.contributor.affiliationUniversity of Edinburghen_UK
dc.contributor.affiliationScottish Collaboration for Public Health Research & Policyen_UK
dc.identifier.isiWOS:000363303600001en_UK
dc.identifier.scopusid2-s2.0-84944457822en_UK
dc.identifier.wtid585421en_UK
dc.contributor.orcid0000-0003-3242-0213en_UK
dc.contributor.orcid0000-0002-8393-2342en_UK
dc.date.accepted2015-10-04en_UK
dcterms.dateAccepted2015-10-04en_UK
dc.date.filedepositdate2015-10-28en_UK
rioxxterms.apcpaiden_UK
rioxxterms.typeJournal Article/Reviewen_UK
rioxxterms.versionVoRen_UK
local.rioxx.authorRing, Nicola A|en_UK
local.rioxx.authorBooth, Hazel|0000-0003-3242-0213en_UK
local.rioxx.authorWilson, Caroline|en_UK
local.rioxx.authorHoskins, Gaylor|0000-0002-8393-2342en_UK
local.rioxx.authorPinnock, Hilary|en_UK
local.rioxx.authorSheikh, Aziz|en_UK
local.rioxx.authorJepson, Ruth|en_UK
local.rioxx.projectInternal Project|University of Stirling|https://isni.org/isni/0000000122484331en_UK
local.rioxx.freetoreaddate2015-10-28en_UK
local.rioxx.licencehttp://creativecommons.org/licenses/by/4.0/|2015-10-28|en_UK
local.rioxx.filenameRing et al_BMC Family Practice_2015.pdfen_UK
local.rioxx.filecount1en_UK
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