Table 1 Summary of findings from our earlier systematic review of RCTs and qualitative synthesis

1.

Systematic review of RCT interventions[8]

Fourteen studies (15 papers) from six countries:

- Thirteen trials reported increased action plan promotion (for example, more patients/carers with action plans) and/or use resulting from their intervention. One study reported its intervention had no effect on action plan outcomes [11].

- Most trials reported interventions which encouraged the promotion of action plans (for example, number of action plans issued by professionals). Few trials measured actual action plan use.

- Mechanisms encouraging the promotion of action plans included interventions such as the Australian 3+ plan [9] and postal prompts for asthma review with partially completed personalised asthma plans [12].

- Mechanisms encouraging increased action plan use included the use of a telephone consultation post-hospital discharge by an asthma educator [13].

2.

Systematic review and qualitative synthesis[10]

Nineteen studies (20 papers) from five countries:

- There is a mismatch between what patients/carers want from action plans and what is currently provided by professionals.

- The different explanatory models held by patients/carers and professionals towards asthma and its management contribute to this mismatch.

- To overcome such barriers, asthma plans require to be tailored to patient/carers (for example, customised to their needs and jointly negotiated) and address the wider issues of living with a long-term condition.

- This requires key elements of communication and partnership working between professionals and patients/carers to encourage shared decision-making, joint negotiation of goals and understanding of their different explanatory models of asthma.