Expectations and attitudes in primary care towards home-based testing for diagnosing asthma: a mixed-methods study

BACKGROUND: Asthma is frequently misdiagnosed because clinic-based tests can miss its natural variability. AIM: As part of early stakeholder engagement, this study aimed to examine primary care healthcare professionals' (HCPs') views on using handheld spirometer and fractional exhaled nitric oxide (FeNO) for home-based diagnostic testing. DESIGN & SETTING: This was a two-phase mixed-method study. Phase 1 involved two focus groups with primary care HCPs in North West England. Phase 2 involved a national electronic survey distributed to primary care HCPs across the UK. METHOD: We used nominal group technique in focus groups to identify key priorities for home-based asthma strategies, which informed the development of the national survey in phase 2. RESULTS: Twenty-one primary care HCPs took part in focus groups. Advantages, challenges, and facilitators for implementing home-based asthma diagnostics were identified. A total of 104 primary care HCPs completed all survey questions. Responders represented a wide demographic and practices were across all levels of socioeconomic deprivation. Only 3.8% of responders considered home-based diagnostic strategies unlikely to be feasible. The most frequently cited barrier was high device cost, while patient engagement and device accessibility were identified as the most important enablers. Most responders highlighted more accurate asthma diagnosis as key potential benefits. CONCLUSION: Home-based asthma diagnosis using handheld spirometry and FeNO is generally viewed favourably by primary care professionals based on survey findings, although implementation challenges are multifaceted. Success will require system-level changes in how home-based testing is delivered and supported. The subsequent phase involves evaluation of test feasibility and accuracy, followed by assessment of clinical and cost-effectiveness.