ArticleBMJ open2026
Challenges in translating GINA asthma recommendations into practice: a qualitative study of healthcare professionals in Jordan.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo explore barriers and enablers to the implementation of the Global Initiative for Asthma (GINA) recommendations in Jordan, building on prior quantitative survey findings. We aimed to examine healthcare professionals' experiences, perceptions and contextual challenges in translating guideline awareness into practice.
designQualitative descriptive study using semi-structured interviews. Analysis was inductive thematic, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).
settingHealthcare services in Jordan, including public hospitals, private hospitals, outpatient clinics and community pharmacies, spanning both urban and semi-urban areas.
participants28 healthcare professionals were purposively sampled to capture diverse roles, sectors and levels of experience. The sample included physicians (general practitioners and pulmonologists), pharmacists (community and hospital), nurses and Doctor of Pharmacy (PharmD) graduates. Eligibility required direct involvement in the management and counselling of adult patients with asthma within the preceding 12 months. PRIMARY OUTCOME MEASURES: Perceptions of and experiences with implementing GINA recommendations in clinical practice, focusing on provider-level, system-level and patient-level barriers and enablers.
resultsEight interrelated themes were identified. A consistent 'know-do gap' emerged, whereby clinicians were aware of guidelines but reverted to habitual practice due to insufficient training, scepticism or lack of support systems. Limited diagnostic capacity, particularly the absence of spirometry in public settings, led to symptom-based management. Pharmacotherapy decisions were shaped by patient demand, entrenched short-acting β₂-agonist use and affordability concerns. Inhaler technique counselling and written action plans were infrequently provided, largely due to workload and unclear interprofessional roles. Patients' beliefs (eg, steroid fears, avoidance of inhalers during Ramadan, low health literacy) further impeded adherence. Despite these barriers, participants proposed pragmatic solutions, including concise locally adapted tools, structured Continuing Medical Education (CME), digital decision support, pharmacy-based inhaler technique clinics and public awareness campaigns.
conclusionsAsthma care in Jordan reflects a gap between GINA awareness and consistent application, driven by resource, organisational and cultural barriers. Improving outcomes will require system-level investment in diagnostic infrastructure, sustainable access to controller medications, interprofessional care models and culturally tailored patient education. These findings highlight the need for a coordinated national strategy to strengthen guideline implementation and provide a basis for developing policy and practice interventions across similar middle-income settings.
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