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How young children learn independent asthma self-management: a qualitative study in Malaysia
  1. Siti Nurkamilla Ramdzan1,2,
  2. Ee Ming Khoo2,
  3. Su May Liew2,
  4. Steven Cunningham1,
  5. Marilyn Kendall1,
  6. Nursyuhada Sukri2,
  7. Hani Salim1,3,
  8. Julia Suhaimi2,
  9. Ping Yein Lee3,
  10. Ai Theng Cheong3,
  11. Norita Hussein2,
  12. Nik Sherina Hanafi2,
  13. Azainorsuzila Mohd Ahad4,
  14. Hilary Pinnock1
  1. 1 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
  2. 2 Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  3. 3 Department of Family Medicine, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
  4. 4 Lukut Health Clinic, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
  1. Correspondence to Professor Hilary Pinnock, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh EH8 9YL, UK; hilary.pinnock{at}


Objective We aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.

Design This is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.

Settings We identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.

Results Ninety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.

Conclusion Children learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.

Trial registration number Malaysian National Medical Research Register (NMRR-15-1242-26898).

  • asthma
  • children
  • qualitative research
  • general paediatrics
  • patient perspective

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  • Collaborators RESPIRE collaborators.

  • Contributors All authors contributed to study conception. SNR, EMK, NS, JS, PYL and ATC performed the data collection and checking of the transcripts. SNR, EMK, SML, NS, HS, NH, JS, PYL, NSH, ATC, AMA and HP coded and conducted data analysis. All authors contributed to the interpretation of data. SNR drafted the manuscript and all authors provided critical revisions and editing of the manuscript.

  • Funding International Primary Care Respiratory Group (IF019-2015) and University of Malaya (BKP019-2015) funded this study. SNR is now a PhD student at the University of Edinburgh with the NIHR Global Health Research Unit on Respiratory Health (RESPIRE). RESPIRE is funded by the National Institute of Health Research using Official Development Assistance (ODA) funding.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Malaysian Medical Research Ethics Committee, University Malaya Medical Centre (MECID: 20155-1366).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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