Table 3 The 14 RCT interventions with their elements and detailed study outcomes

Structured community centre asthma education promoting behavioural change with follow-up reinforcement at 6 months [20]

2/2

C

Increased AP use @ 1 year:

- Significantly higher AAP use (P=0.008) than the control group. And, approximately 68% reported willingness to adjust medications.

One-off post-hospital discharge telephone consultation by an asthma nurse. Consultation informed by empowerment theory [13]

2/2

C

Increased and promoted AAP use @ 6 months:

- More participants with AAP than control group: 88% vs. 72% (P=0.001)

- Greater frequency of AAP use than in control group: 32% used often versus 22% & 56% used occasionally (vs. 51%)

Internet-based asthma management tool for patients and physicians with decision support system [21]

2/2

C

Increased AAP use @ 6 months:

- More participants used an Internet-based AAP (88%) than an AAP from a specialist (66%) or from a GP (6%) (P <0.001)

Promoted AAP use at 1 to 2 years post-intervention

Interactive educational seminar for doctors aimed at encouraging behavioural change during their clinical consultations[22]

4/0

C

Promoted AAP use @ 2 years:

- More parents had written doctor information about changing medicines in response to symptom changes (P=0.05)

- Doctors commended parents for taking right asthma management actions (P=0.02), enquired about parent medication fears/concerns (P=0.02), explained the short-term therapeutic plan (P=0.03) and made it easier for families to follow medication instructions (P<0.004)

Proactive, system of asthma care (3+ asthma management plan) including invites for asthma review and patient education[9]

3/1

A

Promoted use @1 year:

- More children had an AAP (44% vs. 34%; OR 2.2 95% CI 1.2-4.1)

Pre-discharge asthma education by a specialist asthma nurse[24]

3/1

B

Promoted use up to 1 year:

- At 1 month: More patients had an AAP (P <0.0001)

- On re-admission to hospital up to 1 year: more patients had an AAP (P <0.0001)

Monthly telephone reinforcement for 1 year by a non-healthcare worker[23]

3/1

C

Promoted use at @ 1 year:

- More than 70% of participants reported improved understanding of AAP use

Postal prompts inviting patients for asthma review with intervention groups receiving a partially completed or blank AAP [12]

2/2

B

Promoted use @1 year:

- More participants reported increased patient understanding of how to use AAP (OR 2.20, 95% CI 1.13-4.30) and usefulness of their AAP (OR 2.65, 95% CI 0.87-7.99)

Promoted AAP use at less than 1 year post-intervention

One-off small group education session encouraging self-management [28]

2/2

C

Promoted AAP use @ 10 months:

- AAP ownership higher (P <0.001)

Asthma education (for example, self-management skills) in a community asthma education centre by a nurse and non-healthcare community workers [25]

2/2

C

Promoted AAP use @ 9 months:

- More children (P=0.0001) and adults (P=0.01) with AAP

- Better knowledge of action in response to gradually worsening asthma (for adults P=0.005 and parents P >0.05) and suddenly worsening asthma (adults P <0.01)

General practice asthma clinic (including asthma management education) provided by nurse and doctor [26]

2/2

C

Promoted AAP use @ 6 months:

- More in intervention group (75%) had written AAP (vs. 65% of controls). When adjusted for baseline measures and clustered by doctor, OR of 1.62 (95% CI 0.82-3.22)

Education (over at least two sessions) by a specialist asthma nurse prior to hospital discharge [27]

2/2

C

Promoted AAP use @ 6 months:

- 86% of intervention group had AAP vs. 17% of control group (P <0.01). Greater numbers ‘chose self-management’, for example, increased inhalers in intervention group compared to controls (77% vs. 57% P <0.01)

Weekly school-based asthma clinic by a school nurse. Clinic targeted to needs of adolescents [29]

2/2

C

Promoted AAP use @ 6 months:

- More in intervention group had an AAP (P <0.001; OR varied between schools (P=0.01)

Had no effect on AAP promotion or use at 1 year post-intervention

Primary care team quality improvement initiative which included staff coaching and learning [11]

0/4

C

No effect on AAP promotion or use @ 1 year