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

IntroductionWork-related asthma (WRA) is prevalent yet under-recognized in UK primary care. The aim of this systematic review was to identify behaviour change interventions (BCI) intended for use in a primary care setting to identify any chronic disease, that may be used in the context of WRA. The study was registered on the PROPSPERO database (19/04/2023; CRD42023418316) and received no funding. MethodsWe searched CCRCT, Embase, PsychINFO and Ovid MEDLINE databases (1st January 1946 - 6th March 2023) for any observational or experimental study which described the development or evaluation (or both) of a BCI for case finding any chronic disease in a primary care setting, aimed at either healthcare professionals or patients or both. We included case reports, series and conference abstracts, and excluded existing reviews and protocols, and abstracts not in English. Abstracts and subsequent full text articles were assessed by two blinded, independent reviewers, and disagreement resolved by consensus. The primary author undertook quality assessments for a variety of methodologies, with quality control by a second reviewer. We undertook narrative synthesis for a variety of outcomes of usability and effectiveness, and for BCI development. Results18 studies (14 papers and 4 conference abstracts) were included following full-text review, from an initial literature search yielding n=768 citations for screening, of which there were 3 randomised control trials, 1 uncontrolled experimental study, 4 primarily qualitative studies and 10 studies employing recognized multi-step BC methodologies. Quality varied depending upon the methodology used. None of the studies were concerned with identification of asthma. BCIs had been developed for facilitating screening programmes (5), implementing guidelines (5) and individual case finding (8). Six studies measured effectiveness, in terms of screening adherence rates, pre- and post-intervention competency, satisfaction and usability, for clinicians, though none measured diagnostic rates. DiscussionSingle and multi-component BCIs have been developed to aid identification of chronic diseases, though not asthma or work-related asthma specifically. Development for the majority has used BC methodologies that involve gathering data from a range of sources, and develop content specific to defined at-risk populations. Nevertheless, such methodologies could be used similarly to develop a BCI for WRA in primary care settings.