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Qualitative evaluation of asthma services for young people: a sequential simulation study
  1. Martha Fawcett1,
  2. Charles Coughlan1,
  3. Elizabeth McGeorge1,
  4. Ambreen Imran2,
  5. Fernando Bello2,
  6. Roger Kneebone2,
  7. Mando Watson1
  1. 1Connecting Care for Children, Imperial College Healthcare NHS Trust, London, UK
  2. 2Imperial College Centre for Engagement and Simulation Science, Imperial College London, London, UK
  1. Correspondence to Dr Charles Coughlan, Connecting Care for Children, Imperial College Healthcare NHS Trust, London W2 1NY, UK; charles.coughlan{at}


Background Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation.

Method We designed a sequential simulation focusing on routine asthma management in young people aged 12–18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis.

Results 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care.

Conclusion Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.

  • sequential simulation
  • patient experience
  • inter-professional education
  • qualitative research
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  • Contributors All authors were involved in the development of the simulation and workshop. MF and CC performed independent thematic analyses of the transcribed data. MF wrote the first draft, which was critically revised for important intellectual content by CC, EM and MW. MF, CC and EM contributed equally to this paper. All authors approve the final version of the manuscript.

  • Funding CC and EM received small grants worth £800 and £375, respectively, from the National Institute for Health Research, via the Imperial College London Biomedical Research Centre Small Grants Fund. Funds were used to provide expendables on the day and to incentivise CYP to participate in the initial semi-structured interviews and sequential simulation. AI’s position was supported by a grant from the Imperial Health Charity.

  • Competing interests MW is cofounder of Connecting Care for Children, an organisation that promotes integrated child health.

  • Patient consent for publication Not required.

  • Ethics approval This project was discussed with the Research Ethics Committees at Imperial College London and Imperial College Healthcare NHS Trust. Both committees advised that formal research ethics were not required. After consultation with the Trust’s Caldicott Guardian, approval was granted for a service evaluation.

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

  • Data availability statement The results of this study are underpinned by transcribed recordings made during post-simulation discussions. Deidentified, encoded transcriptions are available on reasonable request. Data will be made available to researchers who provide a methodologically sound proposal and where data will allow them to achieve their stated aims. Data will be available from immediately after publication to five years after publication. Proposals should be directed to

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