Development of intervention strategies to improve awareness and self-efficacy among adults with asthma during the haze crisis in Malaysia: A community based study. By Hani Syahida Salim

Background: Asthma affects almost 235 million people globally (1) In Malaysia, the prevalence of asthma among adults is estimated at 4.2% with asthma related deaths at 1.2% as of 2014.(1)

Cont. The main risk factor for asthma are inhaled substances that can trigger an allergic reaction of the airway. These inhaled substances include outdoor substances such as haze and indoor substances such as cigarettes smoking. Like most Southeast Asian countries, haze from forest burning from Indonesia caused surged of asthma exacerbations attendance to out-patients clinics and hospitals in the region.(2,3)

Image 1: Satellite image of hot spots in Southeast Asia region and areas covered with smoke during the 2015 haze crisis. Courtesy of Malaysian Meteorological Department

Literature reviews The self-efficacy concept stemmed from Bandura’s Social Cognitive theory. (4) It describes how personal factors, environmental factors, and human behaviour affect each other.

There are lacking of local and Asian data on asthma self-efficacy to date. One study done in the United States which include a small portion of Asian subjects and conclude that asthma self-efficacy is lower in this group of subjects and leads to unfavourable clinical outcomes.(5) However, there are over-whelming evidence that supported asthma self-efficacy improves asthma control, patients’ satisfaction, reduces exacerbations and admissions and improves quality of life.(6,7)

Objectives To determine the level of awareness, self-efficacy and its determinants among adults asthma patients in Malaysia. To explore the needs initiate and support self-efficacy among adults with asthma in Malaysia To develop an intervention to improve awareness and self-efficacy among adults with asthma in Malaysia.

Methodology Phase 1 Design: Cross-sectional study Tool: KASE-AQ ( Knowledge, attitude & self-efficacy asthma questionnaire) Population: Participants are from primary care clinics in Sepang District. Sepang District is located at the central, west coast of Malaysia comprising of urban, suburban and rural areas which is representatives of Malaysia population’s landscape. Recruitment: Systematic random sampling of patients with asthma aged >18 years.

Cont: Phase 2: Design: Qualitative study Population: Participants are from primary care clinics in Sepang District. Sepang District is located at the central, west coast of Malaysia comprising of urban, suburban and rural areas which is representatives of Malaysia population’s landscape.

Cont: Phase 3: Based on the finding of phase 1 and literature reviews, intervention strategies will be developed to improve awareness and self-efficacy among patients with asthma during the haze crisis.

Questions to discuss: What is the role of mobile app e.g. API warning, educational media advertisement to create awareness of danger to exposure to air pollutant? What are the most effective strategies to promote self-efficacy i.e. online or mobile app consultation among asthmatic patients during haze crisis in primary care setting?

References Ho RC, Zhang MW, Ho CS, Pan F, Lu Y, Sharma VK. Impact of 2013 south Asian haze crisis: study of physical and psychological symptoms and perceived dangerousness of pollution level. BMC Psychiatry. 2014 Mar 19;14:81. Afroz R, Hassan MN, Ibrahim NA. Review of air pollution and health impacts in Malaysia. Environ Res. 2003 Jun;92(2):71-7. Emmanuel SC. Impact to lung health of haze from forest fires: the Singapore experience. Respirology. 2000 Jun;5(2):175-82. Bandura A. Self-Efficacy in Changing Societies. Cambridge University Press; 1995. 334 p. Ejebe IH, Jacobs EA, Wisk LE. Persistent differences in asthma self-efficacy by race, ethnicity, and income in adults with asthma. J Asthma. 2015 Feb 1;52(1):105–13. Taylor SJ, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, et al. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic Review of Self-Management Support for long-term conditions Reddel HK, Bateman ED, Becker A, Boulet L-P, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015 Sep 1;46(3):622–39.

Team members: Hani Salim Ping Yein Lee Su May Liew Nurainul Hana Shamsudin Maliza Mawardi