Registered Nurses' Association of Ontario

Barriers and Methods for Improving Asthma Self-Management

The following is a list of barriers to asthma self-management for which persons with asthma can be assessed. The barriers and methods for supporting self-management below have been compiled from information identified within the systematic review, from AGREE II-appraised guidelines, by the expert panel, and/or by external stakeholder feedback.

For further information on self-management in chronic conditions, please refer to the RNAO BPG Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients.


Barriers to Self-Management of Asthma

Methods for Improving Self-Management

  • Lack of effective communication between the person and the health-care provider
  • Stigmatization
  • Build a partnership with the person by establishing mutual goals for asthma care
  • Shared decision-making
  • Discuss expectations, fears, and concerns
  • Display open communication by showing attentiveness (e.g., eye contact), providing encouragement with non-verbal communication (e.g., smiling, nodding), using verbal reinforcement for effective management strategies (e.g., “That is great” or “You did the right thing”), and using an interactive conversation style (i.e., asking open-ended questions)
  • If appropriately trained, use motivational interviewing techniques


  • Misperceptions regarding asthma control and asthma management
  • Assess barriers to the person’s ability to follow the plan of care, including misperceptions regarding asthma and its management and cost
  • Assess any cultural beliefs or practices that may influence self-management activities (e.g., “In your community, what does asthma mean?”).
  • Provide asthma self-management education
  • Promote the use of a documented, individualized asthma action plan


  • Erroneous beliefs that asthma medications are not needed
  • Concerns regarding medication side effects (real or perceived)
  • Misunderstanding about medication instructions
  • Misunderstanding regarding the importance of controller therapy in achieving asthma control
  • Forgetfulness
  • Education to improve the appropriate use of medications should address the following:
    • The pros and cons of treatment options
    • The consequences of not following the treatment plan
    • Issues related to asthma medications (e.g., side effects of medications; clarify misperceptions—particularly related to the used of steroid medications)
  • Discuss expectations, fears, and concerns
  • Use technologies that are already part of a person’s daily life (e.g., setting reminders on mobile devices)
  • Encourage the person to use activities of daily living (e.g., shaving, brushing teeth, meal time) as reminders to take medication


  • Difficulties using inhaler devices
  • Multiple inhalers
  • Review and reinforce accurate inhaler technique
  • Simplify management and the action plan as much as possible (e.g., determine whether multiple inhalers might be replaced with fewer; provide clear instruction on the action plan, etc.)
  • Health literacy
  • Socioeconomic factors, including poverty, low education, unemployment, low social support
  • Evaluate the person’s health literacy
  • Tailor the level and amount of education to the person’s level of health literacy
  • Use non-technical, plain language that is clear and unambiguous
  • Seek feedback from the person and confirm understanding (e.g., use teach-back)
  • Order information strategically, speak slowly, and spend more time with the person if necessary
  • Provide education using multiple teaching strategies (e.g., discussion, written materials, videos, interactive websites)
  • Discuss medication cost as a barrier and connect patients to appropriate financial and social supports as required
  • If appropriately trained, use motivational interviewing techniques



Chronic Disease
Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma
Point of Care Resources