Edinburgh Napier University

  Background: Self-management education including receipt of a written asthma action plan improves outcomes for those with asthma but not everyone can use the written word. We devised a set of pictorial representations of each of the components of a typical action plan and now report testing the plans with Somali and Malaysian patients with asthma.

Methods: Participants completed a guessability and translucency questionnaire for all 27 pictograms. Patients were then shown a complete pictorial asthma action plan and the concept of self-management explained. Understanding of the action which the patients would take in each clinical situation was assessed. Information regarding age, gender and school leaving age was recorded.

Results: Ten Somalis with asthma living in Manchester (mean age 43.5 (SD 13.4) years; 1 male, 9 females) and 19 patients with asthma attending an Outpatient clinic in Malaysia were studied (mean age 49.2 (SD 10.8) years; 6 males, 13 females). The Somali group had had little formal education; in the Malaysian group the mean school leaving age was 15 (SD 3.25) years. Guessability and translucency results showed that most of the pictograms were well understood and thought to be good representations. The Somali group scored over 5 for translucency scores for all but eight of the 27 pictograms. They had difficulty with pictograms depicting “taking extra doses of reliever medication”, the daytime/night-time use of inhalers and the caution sign. The Malaysian group rated the pictograms highly, but some left blank responses for some items such as the dry powder inhaler, reflecting uncommon use of this inhaler device in that country. All could state their medication, increase their inhalers in Zone 2, take appropriate action for Zone 3 and could suggest when to seek emergency treatment.

Conclusion: The pictorial plans were well understood in both groups and comprehensibility was similar among patients in these two cultural groups to that which we have previously demonstrated in a UK population.