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Respir Care. 2016 Dec;61(12):1588-1596. Epub 2016 Nov 8.

Culturally Specific Evaluation of Inhaler Techniques in Asthma.

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Faculty of Medicine, Respiratory Medicine Division, Centre for Clinical Epidemiology and Evaluation (C2E2), University of British Columbia, Vancouver, Canada.
Faculty of Population and Public Health, University of British Columbia, Vancouver, Canada.
Institute for Heart and Lung Health, Faculty of Medicine, Respiratory Medicine Division, University of British Columbia, Vancouver, Canada.



Little work has been done on identifying the impact of educational materials developed by immigrant patients themselves, along with their caregivers and health professionals in terms of inhaler use technique. The purpose of this study was to evaluate understanding of physicians' instructions on asthma management and inhaler techniques in Punjabi and Chinese subjects using educational interventions in their native languages.


Eighty-seven subjects with asthma were randomly assigned to either one of 3 experimental groups (physician-led video, subject-generated community video, or both) or a control group (educational pamphlet). Medication knowledge and inhaler skills were measured during 3 in-person interviews.


Subjects in all 3 experimental groups, when compared with control subjects, demonstrated improvements in the follow-up test in terms of ability to use inhalers correctly (P < .001) and understanding of physicians' instructions (P = .008). Chinese participants showed significantly greater improvements compared with Punjabi participants for the correct use of inhalers (P < .047), and females showed greater improvements compared with male subjects (P = .04).


The educational interventions developed were successful in behavioral modification and beneficial beyond usual care in terms of improving proper use of inhalers and understanding of physicians' instructions. The findings can be translated to health education practice, promoting the development of short, simple, and culturally linguistically appropriate learning materials for patients. Such interventions that draw on patients' life experiences and socio-cultural context can overcome certain limitations of conventional patient education approaches. ( registration NCT01474928.).


asthma; cultural background; educational intervention; inhaler technique; instructional videos; patient engagement

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