Table 3 All included paper findings as reported and the decisions underpinning the harvest plots

Agrawal³⁰ n = 60 children FU: 4 m

Clinical-unscheduled care, 4 m

Compared to controls, children in the intervention group had:

Illustrated as a consistent significant positive effect

Fewer acute asthma events: I: 0.50 (SD 0.71) vs. 1.0 (SD 0.61); p = 0.02

Overall risk of bias: Unclear

Clinical-asthma control, 4 m

Compared to controls, children in the intervention group had:

Illustrated as a consistent significant positive effect

Improved symptom score: (from the symptom diary) I: 21.9 (SD 14.4) vs. C: 33.7 (SD 10.9); p = 0.0006

Fewer nocturnal awakenings: I: 1.75 nights/month (SD 1.30) vs. C: 3.25 (SD 1.20); p = 0.001

Reduced school absenteeism: I: 1.5 days/month (SD 1.4) vs. C: 2.54 (SD 1.79); p = 0.015

Process

Not assessed

–

Behavioural

Not assessed

–

Behera³¹ CCT n = 523 adults

Clinical-unscheduled care, 1 yr

A reduction in hospital admissions is illustrated graphically (the authors state that there was a significant decrease in hospital admissions in the intervention group at FU compared to the control group)

Illustrated as a consistent significant positive effect

FU: 2 wks, 6 m, 1 yr Overall risk of bias: high

Clinical-asthma control, 2 wks, 6 m, 1 yr

Symptom scores decreased in both groups

Illustrated as a consistent significant positive effect

I: Baseline: 18.14 (SD 41.23) vs. FU 1 yr: 12.61 (SD 28.66)

C: Baseline: 18.76 (SD 42.64) vs. FU 1 yr: 10.69 (SD 24.30)

Logistic regression: compared to the control group, more intervention group patients showed a significant improvement in symptom scores at 2 w, 6 m and 1 yr (p < 0.001)

Process, 2 wks, 6 m, 1 yr

Knowledge scores increased significantly in the intervention group and fell in the control group;

Illustrated as a consistent significant positive effect

I: Baseline: 13.04 (SD 4.06) vs. FU 1 yr: 28.13 (SD 15.70); p = < 0.001 C: Baseline: 11.44 (SD 4.0) vs. FU 1 yr: 9.47 (SD 2.89); p = < 0.001

Logistic regression: Compared to the control group, more intervention group patients showed a significant increase in knowledge scores at 2 wks, 6 m and 1 yr (p < 0.001)

Behavioural, 2 wks, 6 m, 1 yr

Reported self-care in acute attacks showed no change in attitudes in either group, but significantly more patients in the intervention group adopted the recommended position (sitting, leaning forward) and practiced breathing exercises during an acute attack as compared to control patients

Illustrated as a significant positive effect but hatched to show inconsistency

Ghosh³² n = 276 adult, adolescent, children/parent

Clinical-unscheduled care, 1 yr (assessed by diary in months 4, 8 and 12)

Fewer total number of ED visits, but no between group difference in proportion with ED visit

Illustrated as positive but hatched to indicate inconsistency

Number of ED visits in the 3-month diary: I: 11.6 (SD 16.2) vs. C: 21.8 (SD 25.0); p = 0.002

Proportion with ED visits in the 3-month diary: I: 42.9 vs. 50.0% (p = 0.117)

Number and duration of hospitalisations were both significantly reduced

Hospital days in the three diary months: I: 5.8 (SD 10.7) vs. 12.5 (SD 19.8); p = 0.016

Proportion hospitalised in the three diary months: I: 27.1 vs. C: 36.8%; p = 0.043

FU: 4 m, 8 m, 1 yr Overall risk of bias: high

Clinical-asthma control, 1 yr (assessed by diary in months 4, 8 and 12)

Fewer productive days lost in the intervention group during the three diary months

Illustrated as a consistent significant positive effect

Day lost: 17.6 (SD = 24.2)/34.1 (SD = 38.8); p = 0.003

PEFR was significantly improved in the intervention group relative to the control group;

Mean PEFR from diary cards I: 332 (SD 50.78) vs. 290 (SD 77.69); p = < 0.001

Process

Not assessed

–

Behavioural

Not assessed

–

Shanmugam³³ CCT n = 66

Clinical-unscheduled care

Not assessed

–

FU: 29 days Overall risk of bias: unclear

Clinical-asthma control, 29th day

Asthma control improved in the intervention group compared to the control group

Illustrated as a consistent significant positive effect

Mean ACT score for each question was greater in the intervention group at FU: p < 0.05

(Overall mean ACT scores are not reported)

Lung function showed a greater increase in the intervention group compared with control

PEFR (L/min): Baseline: I: 282 (SD 95) vs. C: 265 (SD 93); FU: I: 336 (SD 88) vs. C: 268 (SD 85); p = < 0.05

Process

Not assessed

–

Behavioural

Not assessed

–

Griffiths³⁴ n = 44 practices/324 – (South Asians I: 95 C: 69 n = 164), adults, adolescents, children

Clinical-unscheduled care, 1 yr

[Note: these data are an a priori sub-group analysis]

Illustrated as a consistent no effect

^aTime to first unscheduled care effect on South Asians was not significant between intervention and control; South Asians HR 0.72, 0.48 to 1.09

^aProportion attending unscheduled asthma care: no between group differences in whole population. No data for South Asian sub-group, but authors state that ‘intervention effect was non-significant for other sub-group analysis’

FU: 2 m, 9 m, 1 yr Overall risk of bias: low

Clinical-asthma control, 2 m, 1 yr

[Note: these data are an a priori sub-group analysis]

Illustrated as a consistent no effect

Symptoms: no between group differences in whole population. No data for South Asian sub-group, but authors state that ‘intervention effect was not significant for other sub-group analysis’

Process

Not assessed

–

Behavioural, 2 m, 1 yr

[Note: these data are an a priori sub-group analysis]

Illustrated as a consistent no effect

Self-management behaviour: no between group differences in whole population. No data for South Asian sub-group, but authors state that ‘intervention effect was not significant for other sub-group analysis’

Griffiths³⁵ n = 84 practices/375 elders, adults, adolescents, children, primary and secondary care clinicians

Clinical-unscheduled careI: 171 days/C: 189 daysI: 72 days/ C: 339 days1 yr

Unscheduled care: there was no between group difference in healthcare use

Illustrated as a consistent no effect

^aTime to first unscheduled contact FU: HR = 1.19 (0.92 to 1.53); p = 0.185

Proportion without unscheduled care FU: OR = 0.72 (0.45 to 1.16); p = 0.175

Time to first unscheduled primary care contact FU: HR = 1.20, 0.92 to 1.57 p = 0.177

Time to first routine review in primary care FU: HR = 2.22, 1.67 to 2.95 p = < 0.001

Corticosteroid prescriptions: There was no between group difference in steroid prescriptions

Steroids FU: I: 1.16 vs. 0.98 Adjusted incidence rate ratio: 1.14 (0.87–1.49)

FU: 3 m, 1 yr Overall risk of bias: low

Clinical-asthma control, 3 m, 1 yr

Asthma control: there was no between group difference in symptom score

Illustrated as a consistent no effect

Process, 3 m, 1 yr

Symptom score FU 1 yr: 9.9 (SD 5.0) vs. C: 10.1 (SD 4.2) AHR: −0.04 (−1.16 to 1.09); p = 0.949

Self-efficacy was improved at 3 m but not at 1 yr follow-up;

Illustrated as a consistent no effect. Another bar plotted to illustrate the 3 m finding—as a consistent significant positive effect

At 3 months: I: 6.7 (2.1) vs. C: 6.3 (1.9) AHR: 0.44 (0.05 to 0.82); p = 0.027

At 12 months: I: 6.4 (1.8) vs. C: 6.3 (1.6) AHR: 0.25 (−0.13 to 0.63); p = 0.188

Behavioural

Not assessed

–

Moudgil³⁶ n = 689 (White Europeans 345, Indian subcontinent 344); adults, adolescents, children

Clinical-unscheduled care, not stated ISC: n = 294 (I: 151 C: 143)

[Note: these data are an a priori sub-group analysis]

Illustrated as a consistent no effect

Number of asthma events/episodes for South Asians: no between group differences

^aProportion with an admission. I: 5.3 vs. C: 6.3% OR 0.83 (0.28 to 2.44); p = 0.9081

Proportion with an A&E attendance. I: 1.4 vs. C: 4.0% OR 2.92 (0.52 to 21.2); p = 0.3184

Proportion with out-of-hours primary care. I: 2.8 vs. C: 2.6% FU: OR 0.95 (0.19 to 4.60); p = 1

Proportion with a GP consultation. I: 55 9 vs. 50.3%. OR 0.80 (0.49 to –1.30); p = 0.3971

Proportion with a steroid course. I: 20.3 vs. 19.9%. OR 0.97 (0.53 to 1.79); p = 1

FU: 4 m, 8 m, 1 yr Overall risk of bias: High

Clinical-asthma control, 1 yr ISC n = 280

[Note: these data are an a priori sub-group analysis]

Illustrated as a consistent significant positive effect

Quality of life in South Asians was significantly better in the intervention group

Change in AQLQ FU: I: 0.11 vs. −0.15. Between group mean difference 0.26 (0.17–0.36); p = < 0.001

Process

Not assessed

–

Behavioural

Not assessed

–

Poureslami³⁷ n = 92 (47 Chinese, 45 Punjabi); Adults

Process, 3 m, 6 mPunjabi n = 43

[Note: these data are an a priori sub-group analysis]

Insufficient data

^aKnowledge: no comparison data for intervention and control groups

FU: 3 m, 6 m; 1 telephone survey interview Overall risk of bias: unclear

Behavioural, 3 m, 6 m

[Note: these data are an a priori sub-group analysis]

Insufficient data

Punjabi n = 43

Understanding physician instructions; on ^amedication and proper inhaler use skills: no comparison data for intervention and control groups

Blixen⁴² n = 28, Adults

Clinical-unscheduled care, 3 m, 6 m

Healthcare use: no data provided, though stated as no significant between group differences

Illustrated as a consistent no effect

Clinical-asthma control, 3 m, 6 m

Quality of life: There was no significant between group differences

Illustrated as a consistent no effect

Overall AQOL score. FU 6 m: I: 4.59 (SD 1.48) vs. C: 4.43 (SD 1.52); p = 0.12

FU: 3 m, 6 m Overall risk of bias: high

Process

Not assessed

–

Behavioural, 3 m, 6 m

Self-management behaviours: no data, though stated as no-significant between group differences

Illustrated as a consistent no effect

Fisher³⁸ n = 249 Adolescents, children, parents

Clinical-unscheduled care, Quarterly for 3 yrs

^aAcute care: no data given (results illustrated graphically), though authors stated no significant between group differences in acute care (hospitalisations and ED attendances p = 0.35)

Illustrated as a consistent no effect

Clinical-asthma control

Not assessed

–

FU: 3, 6, 9, 12, 16, 20, 24, 28, 32, 36 m Overall risk of bias: unclear

Process

Not assessed

–

Behavioural, Every quarterly until 3 yrs

^aAsthma management: no significant between group differences in the non-validated assessment of parent’s reported attitude about asthma and asthma management

Illustrated as a consistent no effect

Attitudes about asthma FU: I: 2.34 vs. C: 2.24 (p = 0.35)

Appropriate thresholds for seeking help Baseline: I: 30 vs. C: 47%; FU: I: 51 vs. C: 53% p = 0.77

Fisher⁴⁶ n = 191/parents, coaches

Clinical-unscheduled care, 1 yr, 2 yr

^aHospitalisation Compared to controls, the intervention group had fewer hospitalisations;

Illustrated as a consistent significant positive effect

Hospitalised at least once FU I: n = 35/96 (36.5%), 55 vs. C: 55/93 (59.1%); 95% CI (0.11–0.34); p = .002

FU: 6, 12, 18, 24 m Overall risk of bias: low

Clinical-asthma control

Not assessed

–

Process

Not assessed

–

Behavioural

Not assessed

–

Ford⁴³ n = 241 (African American = 163, Caucasian = 78)

Clinical-unscheduled care, 4 m, 8 m, 1 yr

^aED visits No impact [Note: these data are an a priori sub-group analysis]

Illustrated as a consistent no effect

ED visits/year I: Baseline: 5.0 (SD 3.6) vs. FU 2.7 (SD 3.3); C: Baseline: 6.7 (SD 8.4) vs. FU: 4.8 (SD 6.8)

No between group comparisons reported

Clinical-asthma control, 4 m, 8 m, 1 yr

Limited days of activity No impact [Note: these data are an a priori sub-group analysis]

Days/person: I: Baseline: 20.6 (SD 25.4); FU: 18.7 (SD 36.8) C: Baseline: 27.8 (SD 33.4); FU: 27.9 (SD 55.7), no between group differences reported

FU: 4 m, 8 m, 1 yr Overall risk of bias: high

Process, 1 yr

^aKnowledge and beliefs: no effect [Note: these data are an a priori sub-group analysis]

Illustrated consistently no effect

Mean scores I: Baseline: 14.1 (SD 2.9); FU: 14.6 (SD 3.2) C: Baseline: 14.3 (SD 2.3); FU: 14.7 (SD 2.3)

No between group differences reported

Behavioural

Not assessed

–

Keslo³⁹ n = 52 adults

Clinical-unscheduled care, 1 yr

Unscheduled care: compared to controls, the intervention reduced ED visits but not hospitalisations

Illustrated as a significant positive effect but hatched to show inconsistency

^aChange in ED visits Baseline: I: 4.4 (SD 2.7) vs. C: 3.4 (SD 2.6); FU: I: 2.6 (SD 2.6 vs. C: 3.5 (SD 2.7) Between group difference p = < 0.01

Change in hospitalisations Baseline: I: 1.3 (SD 1.3) vs. C: 1.0 (SD 1.2); FU: I: 0.5 (SD 0.8) vs. C: 0.5 (SD 0.9) Between group difference p = 0.37

FU: 1 yr, telephone every 2 wks to every 6 m Overall risk of bias: unclear

Clinical-asthma control

Not assessed

–

Process, After intervention

No data reported for knowledge

Insufficient data

No data reported for medicine treatments

Behavioural

Not assessed

–

Keslo⁴⁴ n = 39, adults

Clinical-unscheduled care, 1 yr, 2 yr

Unscheduled care: Intervention group had a greater reduction in hospitalisations and ED visits

Illustrated as a consistent significant positive effect

^aChange in ED visits. Median (IQR) visits 2 years, I: 0 (0, 0) vs. C: 2 (1.5, 2); p = < 0.05

^aChange in hospitalisations. Median (IQR) hospitalisations, I: 0 (0, 0) vs. C: 0.5 (0, 1); p = < 0.05

FU: every month then every 2–3 m Overall risk of bias: High

Clinical-asthma control 6 m, 1 yr, 18, 2 yr

No control group data reported for quality of life, asthma bother or peak flows

Insufficient data

Process, before and after intervention

No control group data reported for Knowledge control group

Insufficient data

No control group data reported for medicine treatments control group

Behavioural

Not assessed

–

Velsor-Friedrich⁴⁰ CCT n = 102, children

Clinical-unscheduled care, 2 wks, 5 m, 1 yr

Unscheduled care: the intervention group had significantly more unscheduled visits at 5 m and 1 yr

Illustrated as a consistent significant negative effect

Medical visits at 5 m. Mean (SE) I: 0.12 (0.05) vs. C: 0.02 (0.04)

Medical visits at 1 yr. Mean (SE) I: 0.07 (0.03) vs. C: 0.00 (SD 0.02); p = 0.01

FU: 2 wks, 5 m, 1 yr Overall risk of bias: unclear

Clinical-asthma control, 2 wks, 5 m, 1 yr

Symptom days: greater reduction in days with symptoms in intervention compared to control

Illustrated as a consistent positive effect but hatched to show inconsistency

Symptom days at 5 m. Mean (SE). I: 2.15 (SE 0.30) vs. C: 1.42 (SE 0.21)

Symptom days at 1 yr. Mean (SE). I: 1.26 (SE 0.33) vs. C: 1.49 (SE 0.23); p = 0.047

PEFR: intervention group had greater increase in PEFR at both FU time-points

% increase in PEFR at 5 m. I: 2.9% (SE 2.0%) vs. C: 2.9% (SE 1.0%)

% increase in PEFR at 1 yr. I: 7.5% (2.0%) vs. C: 2.9% (SE 1.2%); p = 0.046

School absences: no between group difference in days absent from school

Days absent at 1 yr. I: 9.03 vs. C: 14.4 days

Process, 2 wks, 5 m, 1 yr

Knowledge, self-efficacy and self-esteem/motivation: no significant between group differences

Illustrated as a consistent no effect

Asthma knowledge test at 5 m: I: 14.05 (SE 0.55) vs. C: 13.35 (SE 0.38)

Asthma belief survey at 5 m. I: 4.23 (SE 0.10) vs. C: 4.15 (SE 0.08)

Self-perception inventory at 5 m. I: 2.80 (SE 0.08) vs. C: 2.85 (SE 0.05)

Behavioural, 2 wks, 5 ms

Self-practice/asthma self-care: No significant between group differences

Illustrated as a consistent no effect

Denyes self-care agency instrument at 5 m: 72.03 (SE 2.46) vs. 70.57 (SE 1.68)

Asthma self-care instrument at 5 m I: 68.87 (SE 2.89) vs. C:70.41 (SE 2.00)

Velsor-Friedrich⁴¹ CCT n = 52, children

Clinical-unscheduled care, 2 wks, 5 m, 1 yr

Urgent medical visits (and medications): no significant between group differences at any time point

Illustrated as a consistent no effect

Urgent doctor visits at 12 m. I: n = 4 (14%) vs. C: n = 5 (20%)

No data; some data on medicine use was provided

FU: 2 wks, 5m, 1 yr, 2 yr Overall risk of bias: unclear

Clinical-asthma control, 2 wks, 5 m, 1 yr, 2 yr

Symptoms, PEFR and school absences: no significant between group differences at any time point

Illustrated as a consistent no effect

Proportion with > 1 day with symptoms/2 wks at 1 yr. I: 14 (50%) vs. C: 13 (54%)

% increase in PEFR from baseline at 1 yr. I: 26.21% (SD 0.22) vs. C: 27.80% (SD 0.31)

Average days absent from school. I: 9.03 vs. C: 14.4

Process, 2 wk, 5 m, 12 m

Knowledge and self-efficacy: Intervention group had higher scores at all time-points, but neither group improved over time

Illustrated as a consistent positive effect but hatched to show inconsistency

Asthma Knowledge: test at 1 yr. Adjusted mean I: 14.28 (SE 0.80) vs. C: 11.88 (SE 0.87); p = 0.03

Asthma belief scale at 1 yr. Adjusted mean I: 4.09 (SE 0.14) vs. C: 3.82 (SE 0.15); p = 0.01

Self-esteem: no significance between group differences at any time point

Self-perception inventory at 1 yr. Adjusted mean I: 2.71 (SE 0.08) vs. C: 2.78 (SE 0.10)

Behavioural, 2 wks, 5 m, 1 yr

Asthma self-care practice/general self-care: intervention group had higher scores at all time-points, but neither group improved over time

Illustrated as a consistent positive effect

Denyes self-care agency instrument. I: 75.55 (SE 2.60) vs. 67.41 (SE 2.82); p = 0.01

General self-care. I: adjusted mean I: 72.99 (SE 3.26) vs. C: 63.75 (SE 3.53); p = 0.2

Velsor-Friedrich⁴⁵ RCT n = 137, adolescents

Clinical-Unscheduled care, 6 m, 12 m

Hospital visits: no significance between group differences p > 0.05 (no other data provided)

Illustrated as a consistent no effect

FU: 2 m, 6 m, 1 yr Overall risk of bias: high

Clinical-asthma control, 6 m, 1 yr

Symptoms reduced in both groups; no significant between group differences

Symptom takes priority. Illustrated as a consistent no effect

PEFR: no significance between group differences

School absences reduced in both groups; no significant between group differences

Process, 6 m, 1 yr

Knowledge, self-efficacy improved in both groups; no significant between group differences

Illustrated as a consistent no effect

Coping frequency/efficacy, no significance between group differences

Behavioural, 6 m, 1 yr

Self-care practice, no significance between group differences

Illustrated as a consistent no effect