Kinley, Emma ORCID: https://orcid.org/0000-0001-5934-7023, Pinnock, Hilary ORCID: https://orcid.org/0000-0002-5976-8386, Huang, Huayi, Sheringham, Jessica, Lo, David, Qureshi, Irtiza ORCID: https://orcid.org/0000-0002-2273-844X, Jackson, Tracy, Quint, Jennifer ORCID: https://orcid.org/0000-0003-0149-4869, Kallis, Constantinos, Davies, Gwyneth A., Gaillard, Erol A. ORCID: https://orcid.org/0000-0003-0996-8133 and Abhyankar, Purva ORCID: https://orcid.org/0000-0002-0779-6588 (2026) The context and mechanisms that contribute to accessible and engaging asthma care: a rapid realist review. European Respiratory Review, 35 (182):260042. ISSN 0905-9180 (Print), 1600-0617 (Online) (doi:10.1183/16000617.0042-2026)

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Abstract

Introduction
Access to and engagement with asthma care could improve outcomes, but there is limited understanding of the reasons for poor engagement and a gap in actionable evidence to inform how to reduce inequities. We aimed to understand the context, mechanisms and outcomes (CMOs) that affect access to and engagement with asthma care and to identify solutions.
Methods
Using rapid realist review methodology, we searched four databases (1999–2024) for studies of any design in asthma populations (>5 years of age) that explored access or engagement in healthcare applicable to the UK health context. We extracted CMO configurations explaining access and engagement with asthma services and synthesised them into overarching theories. External reference group meetings with 16 experts with lived experience and professional expertise were held to discuss preliminary review findings and inform their interpretation.
Results
19 articles reported 16 studies. We identified eight theories from 51 CMOs, grouped under two themes. 1) Demographic and social–cognitive barriers, including socioeconomic and structural barriers, uncertain candidacy resulting in escalation to emergency care, low perceived need hindering engagement and relational accountability driving engagement. 2) Health system barriers, including over-burdened services, fragmented systems disrupting care, feeling unheard hindering youth engagement, and cultural and language barriers. Solutions included digital care, education, developing patient skills, proactive follow-up, training for healthcare professionals, information sharing between services and enhanced professional–patient relationships.
Conclusion
Enhancing system coordination, cultural sensitivity and patient-centredness of care may improve trust and patient–provider communication, leading to better engagement and proactive asthma care.

Item Type:	Article
Additional Information:	Support statement: National Institute for Health and Care Research Programme Development Grants (Grant: NIHR206509). Funding information for this article has been deposited with the Open Funder Registry.
Uncontrolled Keywords:	asthma, rapid realist review
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development
Last Modified:	04 Nov 2026 15:37
URI:	https://gala.gre.ac.uk/id/eprint/54895

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