Identifying the asthma research priorities of people with asthma, their carers and other stakeholders

People living with asthma, their carers, clinicians and policymakers are the end‐users of research and need research that address their individual healthcare needs. We aimed to understand the research priorities of end‐users of asthma research.


INTRODUCTION
In Australia, one in nine people are living with asthma, and it has a major impact on individuals, their carers and the health system. 1,2 Asthma is responsible for more than 30,000 hospitalizations 1 and approximately 400 deaths each year in Australia. 1 In 2018, the National Asthma Strategy (NAS) outlined a comprehensive approach to optimize asthma diagnosis and management in Australia, 3 and highlighted areas for strategic action to bridge the gap between evidence and practice. Research was identified by the NAS as a key enabler of progress in asthma. The NAS also identified that there was a lack of overarching strategic direction for asthma research with various actors each pursuing their own research paths. In addition, there is frequently a misalignment between research goals important to end-users (patients, carers, clinicians), and those identified by researchers. 4,5 This justifies a need to systematically identify consumer research priorities in asthma. The James Lind Alliance, a not-for profit organization in the United Kingdom (UK), promotes priority setting partnerships that allow open communication among people living with a disease, carers, clinicians and policy makers to identify and prioritize the unanswered questions that address their specific needs. This process has previously been successfully used to prioritize research in more than 100 clinical areas. 6 Australia's Medical Research Future Fund (MRFF) recognizes the importance of consumer-driven research, and lists this as a core part of its medical research and innovation strategy 2021-2026. 7 Specifically, it prioritizes research that is driven by meaningful consumer involvement and partnerships, to incorporate priorities that will deliver useful outcomes for the users of research. 7 Whilst not the only method to identify or prioritize research needs, a systematic and transparent process of involving end-users is a crucial requirement to aid policymakers and research funding organizations in making investment decisions. 8 Asthma Australia, the peak body for Asthma in Australia, has undertaken to develop a National Asthma Research Agenda to coordinate asthma research in Australia, based on the priorities of end-users of asthma research. We aimed to understand the research priorities of end-users of asthma research and translate this into a National Asthma Research Agenda to inform research funding and policy decisions.

Study design
A cross-sectional mixed-method study was undertaken. Existing priority setting approaches 6,9 were adapted to use video conferencing and electronic data collection. 10 This enabled broad geographic representation and management of infection control issues. The processes involved were: (1) setting up a steering group to supervise the study; (2) establishing a Priority Setting Partnership; (3) assembling potential research questions and themes using an online survey; (4) processing, categorizing, and summarizing those research themes and questions and (5) workshopping the research themes with their illustrative statements into a top 10 list, using respondent ranking and consensus discussion. 11 Ethical approval was obtained from the Hunter New England Health Human Research Ethics Committee Approval No. 2021/ETH11604.

Steering group
The study authors formed the steering group, which was established to oversee the design and delivery of the project. The steering group was chaired by co-author (Peter G. Gibson). Members were selected based on their specific expertise as it related to the composition recommended by the James Lind Alliance method (Table S1 in the Supporting Information).

The priority setting partnership
The partnership involved key partners: Asthma Australia's Consumer Advisory Council (CAC), a project reference group and an ambassador group. The CAC is a standing committee of 12-15 people with asthma or their carers from diverse background and geographic locations. The CAC is a formal mechanism to facilitate Asthma Australia more broadly engaging with the community to ensure that the interests of consumers and carers are at the centre of Asthma Australia's planning, communication and processes. The CAC provided cognitive debriefing on the survey questions and endorsement of the study results. The reference group included community members comprising persons living with asthma, carers, healthcare professionals and policymakers. The reference group provided advice to the steering group on the development and distribution of the end-user survey as well as the construction of the themes analysed for presentation to the consensus workshops. They were also invited to participate in the consensus workshop.

SUMMARY AT A GLANCE
The burden of asthma is an ongoing challenge. We established Australia's top 10 asthma research priorities. Using a rigorous methodology to capture the voice of end-users can be useful to focus research on what matters to the people who rely on it.
The ambassador group is comprised of leaders of peak organizations and engaged asthma health consumers who share an interest in influencing research policy settings in favour of the needs of people with asthma.

Online survey to establish asthma specific research questions and research themes
We used a non-probabilistic self-selection sampling strategy. Underrepresented populations were targeted in subsequent communications to balance the demographics. Our target participants were people with asthma, their carers, healthcare professionals and policymakers (Table 1). Exclusion criteria included being <12 years and professionals working exclusively in research. Participants were identified through Asthma Australia's consumer and health professional databases. The survey was also advertised via email, newsletters and social media platforms sent out by professional organizations ( Figure 1A). The survey's landing page provided a link and description of participant requirements for the research. Completion of the survey implied consent. Between November and December 2021, the survey was administered online via REDCap ® , 12 hosted by the Hunter Medical Research Institute Newcastle Australia. A printed questionnaire was also offered.
The survey included demographic questionnaires and two free-text questions asking participants (1) 'what would you like to see answered by research to improve living with asthma on a day-to-day basis?' and (2) 'are there any other issues you would like to see answered by research?' At the end of the survey participants could register their interest in participating in the consensus workshops.

Data analysis
Thematic analysis and frequency content analysis were used to analyse the data in two stages. Firstly, all free-text responses were coded following an iterative process 13 ( Figure 1A). This included creating initial codes, which were subsequently categorized. We merged and rephrased similar and duplicate questions or comments as appropriate to create a summary of indicative questions (where possible formatted in Patient, Intervention, Comparison and Outcome [PICO]) and a summary of illustrative statements that represented and reflected all underlying responses, and one overarching theme was developed. We named the theme with simple descriptive themes 14 that were brief enough to convey what the theme is about. 13 Additionally, each theme corresponded to an alphabetical letter to increase information recall, consistent with the principles of the selected methodology. 6 Secondly, specific research questions within themes were content analysed. We did not exclude out of scope questions or comments. NVIVO 12 Pro software program (QSR International, Melbourne, Australia) was used as a data management tool.
All descriptive statistics were analysed using STATA/IC 15 (StataCorp LLC, USA). To enhance visual interpretability, Microsoft excel was used to summarize the frequency count of specific research questions.

Processing and evidence checking of research questions
A group of researchers from the Centre of Excellence in Treatable Traits, Newcastle Australia searched the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register and clinical guidelines to assess the summary questions (within the themes) against published evidence ( Figure 1A). Where evidence was found, the content was analysed to determine the extent to which it addressed the summary question (i.e., totally, partially or unanswered). Questions were removed from themes if found to be totally answered by published research.
Priority setting workshops and ranking of the top 10 research priorities Purposive sampling was used to achieve participant diversity, including geographical location, among workshop participants who were invited to express interest when responding to the initial survey. Between March and April 2022, three online workshops with participants were held. Each workshop was scheduled for 3 h and was facilitated by a member of the steering group who is skilled in James Lind Alliance methods (Anne Mckenzie). To ensure that all voices in the workshop are heard, the recommended method is an adapted nominal group technique (NGT) for Priority Setting Partnerships when choosing their priorities. NGT is a well-established and well-documented approach to decision-making. 15 All participants received pre-reading materials which included all themes and the illustrative statements within them. A summary of illustrative statements avoiding technical language and medical jargon was circulated to participants for increased comprehension. Participants were asked to reflect what themes are most important to inform future asthma research. The workshops were structured in two parts, theme discussion and theme prioritization, using breakout rooms and whole group discussions. During breakout sessions, participants discussed their perspectives on the themes (missing themes or groups of themes which could be collapsed). Breakout rooms were facilitated by steering group members (Anthony W. Flynn, Michele Goldman, Peter G. Gibson, Sundram Sivamalai) and two Asthma Australia senior staff. Breakout facilitators fed back their participants' inputs in whole group discussions, moderated by Anne Mckenzie. Proposed new or collapsed themes were discussed and voting as a whole group was undertaken to adopt changes. A second breakout discussion was conducted to rank the themes, including any new or modified themes. Breakout facilitators supported participants to reach consensus on ranking through discussion and voting. Subsequently, facilitators entered their group ranking into QuestionPro, which, averaging the inputs from the breakout groups, organized the themes into ranked order. The combined ranked themes from all breakout groups were presented, followed by a facilitated discussion, (led by Anne Mckenzie), to refine decisions in the reprioritising of any themes. A change in rank required agreement by more than half of participants using blind voting. Debate and reprioritisation was repeated until consensus agreement was achieved. The steering group did not participate in voting or priority setting. MURAL (virtual whiteboard software) 16 tool was used throughout the consensus workshops. Combined list of the three workshopsestablishing the final top 10 research priority themes Data captured from each of the three workshops were combined (Table S2 in Supporting Information). A two-stage approach was followed, where co-authors (Eleanor C. Majellano, Rose L. Bell, Anne Mckenzie) independently reviewed and collated the workshop rankings using Microsoft Excel. These provided a total score or average for each theme, combining the rank from the three workshops. Co-authors (Eleanor C. Majellano, Rose L. Bell, Anne Mckenzie) compared their individual ranking results and achieved consensus.
Three pre-defined criteria were followed to decide on combining themes ( Figure 1B): (1) If new or collapsed themes recurred in multiple workshops, these were included in the final priority list; (2) where multiple themes were collapsed into one larger theme, all individual themes were given an equal rank. This provided an overall ranked list for post workshop themes and (3) the theme which consistently occurred in the top 10 priorities across all three workshops (common theme, Table S2 in the Supporting Information) that recurred across multiple workshops received the higher ranking. Results were discussed until agreement was reached with all co-authors.

Online survey
We received survey responses from 593 individuals who provided 1446 text comments. Most (83%) participants were people with asthma, female (78%), aged 45-74 and 90% spoke only English at home (Table 1).

Thematic analysis
From the coded data, 24 initial themes were identified. All themes were supported with illustrative statements or indicative questions. Themes were reviewed with all coauthors resulting in a reduction to 20 themes (Table S2 in the Supporting Information). These themes were taken for evidence checking resulting in 18 themes for workshop prioritization (Table S3 in the Supporting Information).

Priority setting workshops
Twenty-nine participants attended the workshops. The majority were female and aged 45-54 (Table 1). Workshop participants proposed some modifications to the 18 themes (Table S3 in the Supporting Information), including two additional new themes: (i) cost of disability aids and (ii) health professional training, standards and quality of care. These themes were not included in the ranking process as they were only raised in one workshop but were included in the final list of themes (Table S3 in the Supporting Information). Participants in workshop one proposed splitting the theme diagnosis and medication (Table S3 in the Supporting Information) however, this was not adopted as this was not raised in the other two workshops. The themes asthma care and asthma self-management were proposed to be collapsed in more than one workshop (Table S3 in the Supporting The top key research themes as prioritized in the priority setting workshops with the highest frequency research questions within themes as revealed in the content analysis.
T A B L E 2 Final top 10 ranking of asthma research themes following priority setting workshop consensus.

Priority Theme
Theme summary Sample illustrative statements 1 Asthma in children This theme relates to the prevention, treatment, impacts and causes of asthma remission in children. It also extends to the impacts and unmet support needs for carers of children with asthma.
Why some children with asthma stop having asthma symptoms or 'outgrow' their asthma.

COVID-19 and asthma
This theme encapsulates the much-needed information on the long-and short-term impacts of COVID-19 for people with asthma, if COVID-19 can cause asthma, and the effects of COVID-19 strategies (such as mask wearing), on people with asthma.
Impacts of COVID-19 on 'lung function/ capacity' and 'risk of long COVID'; overall impact of asthma and COVID-19 on quality of life. 3 Asthma care and self-management This theme included issues surrounding access to and delivery of service, patient-clinician partnership, self-management strategies and patient empowerment.
How to get access to treatments/testing as it varies from hospital to hospital. Easier ways to gauge your own lung function at home.

Diagnosis and medication
This theme relates to new and improved diagnosis tools for asthma, as well as incorporating diagnosis of commonly coexisting conditions (such as allergies) as part of the standard assessment. This theme also highlights issues around medications including side-effects and more personalized medication options to suit different people with asthma.
New ways to better diagnose and confirm asthma. Better and personalized medication options to suit different people and lifestyles.

Managing asthma attacks
This theme talked about improving education and trainings to better recognize and respond during acute asthma attacks.
Building confidence through education and training to better recognize and respond during asthma attacks (for example when to seek emergency medical services).

Causes, prevention and features of asthma
This theme encompasses better understanding of the causes and prevention of asthma, including the role of genes and diet. It also extends to understanding the intergenerational impacts of asthma, development of severe asthma and prevention of irreversible lung damage.
More understanding about what causes asthma and how to prevent it.

7
Mental health This theme focuses on research to understand the relationship between asthma and psychological factors (anxiety and depression), how these impact selfmanagement and wellbeing, and how to manage mental health conditions in people with asthma. The need for a tailored psychological support following a lifethreatening asthma attack was also identified.
More understanding about the relationship between asthma and anxiety or depression. For example, how it triggers asthma. Understanding what causes asthma to develop in older people and if it can be prevented.

9
Severe asthma This theme encompasses better understanding of the features, causes and impact of severe asthma, as well as the relationship between severe asthma and anxiety/depression.
Understanding what causes severe asthma and whether it can be predicted. Coping with anxiety and depression in severe asthma.

10
Asthma and other health conditions Central to this theme was how to best manage asthma with multiple comorbidities, with a particular focus on vocal cord dysfunction.
Effective ways to manage asthma and other health conditions.
Note: Theme names, summary and sample illustrative quotes are reported.
Information). Themes that were prioritized in each of the workshop top 10 lists were: (i) asthma self-management, (ii) asthma care, (iii) asthma in children, (iv) managing asthma attacks, (v) diagnosis and medication, (vi) severe asthma and (vii) COVID 19 and asthma. Figure 2 depicts the top 10 research themes as prioritized in the priority setting workshops along with the most frequent research questions within themes as revealed by the content analysis. Theme summary and illustrative statements are shown in Table 2 and the corresponding specific research questions are described in Table 3. Using the pre-defined criteria agreed by the steering group ( Figure 1B) the themes asthma care and asthma selfmanagement were combined into one theme. The resulting theme combination generated new theme name to asthma care and self-management which ranked as third priority in the overall rank list. The complete final rank list for all themes is presented in Table S3 in the Supporting Information.

Post workshop feedback
Of the 29 attendees, 16 completed the feedback survey and 75% reported feeling satisfied (n = 12) and 81% felt their voice was heard (n = 13). Almost all (94%) agreed that the technology worked well across the workshops (n = 15).

Subgroup analyses of the survey responses
Responses to the two free text questions were separately content analysed including by end-user group, gender and age-groups and mapped to the 18 research priority themes (A-R).

By end-users
For question 1, six predominant themes were identified ( Figure 3). Overall, 75% of end-users wanted research focused on exercise and sleep (this might be due to the examples of asthma limitations being provided in the survey). Common to nearly half of the participants were the themes: asthma in children; causes, prevention and features of asthma; managing acute attacks; and diagnosis and medication. Thirty-four percent of end-users found asthma triggers to be important.
The results of question 1 corresponded with the results of question 2. Over half of end-users desired further research on causes, prevention and features of asthma and diagnosis and medication. Almost half of end-users wanted more research on issues related to asthma care. The themes asthma triggers and asthma in children were also highlighted.

Carers
Carers of different age groups indicated different priorities. Carers aged 25-44 wanted research focused on issues related to asthma in children, whilst carers aged 45-64 proposed questions related to causes, prevention and features of asthma. Carers aged 65-74+ sought research of issues related to diagnosis and medication. A similar response from question 2 was observed ( Figure S1 in the Supporting Information).

Patients
Across all age-groups, a similar pattern of predominant themes (question 1) was identified from among people with asthma. The four most frequent themes were; exercise and sleep, causes, prevention and features of asthma, and asthma triggers. Questions related to the theme diagnosis and medication was common across all age-groups in question 2 ( Figure S2 in the Supporting Information).

Healthcare professionals
Healthcare professionals proposed questions related to four main themes (question 1): asthma in children, exercise and sleep, causes, prevention and features of asthma and diagnosis and medication. Twenty-three percent of healthcare professionals aged 45-64 highlighted questions related to asthma care as important research priorities.
The responses received from question 1 were similar to the responses from question 2 with questions related to asthma in children, and causes, prevention and features of asthma common across all age-groups. Questions related to asthma awareness and stigma were highlighted by 16% of healthcare professionals aged 45-64 ( Figure S3 in the Supporting Information).

By gender
For patients and carers, there was comparability between gender groups among the most frequent responses to both questions. Questions related to exercise and sleep were prominent across genders. However, male carers (14% vs. 1%) and non-binary patients (33% vs. [6% and 4%]) highlighted asthma awareness and stigma as important research. Questions related to causes, prevention and features of asthma, and diagnosis and medication were consistently frequent across genders in response to question 2 ( Figures S4 and S5 in the Supporting Information).
For clinicians, both gender groups proposed questions related to asthma care as important research to improve the daily living with asthma. This result was consistent with the results gained from question 2. There were differences between genders among healthcare professionals where males preferred research focusing on causes, prevention and features of asthma (33% vs. 11%), and diagnosis and medication (33% vs. 7%). This pattern was consistent with the responses to question 2. Conversely, female healthcare T A B L E 3 The 10 research asthma theme priorities with corresponding top 3 research questions with frequency count. professionals highlighted research focus on questions related to asthma in children (22% vs. 17%). This was consistent with their response to question 2 (19% vs. 0%) ( Figure S6 in the Supporting Information).

DISCUSSION
We report the priority research themes from the perspectives of end-users of asthma research, an approach not previously taken in Australia. The priority research themes each describe a programme of research around a specific issue. We found that of the top 10 themes, seven themes were consistently ranked in the top 10 across all of the consensus workshops, strengthening the validity of the final top 10 list. This study provides a valuable insight in understanding important research priorities for end-users of asthma. To our knowledge this is the first national priority setting partnership for asthma in Australia which has the potential to inform future research direction in this area using a rigorous, transparent and inclusive process.
Our results reveal broad themes reflecting a range of existing challenges faced by people with asthma, their carers and the insights and challenges faced by the people who care for them. Whilst they appear broad and arguably well researched when presented as themes, the questions posed within the themes point to the perseverance of fundamental issues faced by people with asthma, and reinforces the evidence-practice gap highlighted in the 2018 National Asthma Strategy. Programs of research addressing these priorities have the potential to reduce the burden of asthma on the people with the disease which is significant.
Among the top 10 priorities, the themes which were prioritized consistently across each of the three workshops are discussed further below:

Asthma in children
A desire for research concerning asthma in children was common among end-users. Specific questions raised include asthma remission and how this can be achieved. This is also an emerging area in recent published literature. [17][18][19] How to define and implement the right treatment plan for children, and supporting families of children with asthma were an issues included in this theme.
End-users also proposed questions on; preventing future asthma symptoms through perinatal care, the impact of regular asthma symptoms on their growth and wellbeing, and effective treatment pathways for children. It is also worth noting that the sub-group analysis showed asthma in children as a predominant theme among end-users.

COVID 19 and asthma
Given the need for more data COVID's long and short term impact, 20 interaction between COVID and asthma, 21,22 and the anxiety people with asthma reported during the pandemic, 23 it is not surprising that COVID and asthma emerged as a common theme. End-users raised questions which have been repeatedly asked of Asthma Australia 23 including the impact of masks on people with asthma and the unique experience of people with asthma who have COVID. The priority of this theme is also reflected by clinicians and researchers. 20 Asthma care and self-management Care fragmentation and inequity is widespread and has been associated with poor health outcomes. 24,25 End-users expressed a common desire for researching effective training and educational strategies for improving asthma knowledge among clinicians. End-users also sought research for improving patient-clinician partnerships and team collaborations between healthcare professionals involved in asthma care. The importance of timely access to asthma care regardless of geographical characteristics was also highlighted by the end-users. Asthma selfmanagement has been acknowledged as a significant element in improving asthma outcomes and patients' quality of life. 26 Similarly, health literacy and patient empowerment have been recognized as critical components for chronic disease management. 27 End-users are wanting research focused on improving health literacy. Empowering them and their families with knowledge of medication management, asthma control and device use. End-users also sought for research on the most feasible and acceptable home-care based plans.

Diagnosis and medications
Asthma misdiagnosis and overdiagnosis has been reported on in asthma. 28,29 Whilst spirometry is a useful component of assessment for diagnosing asthma, it is often underused in primary care due to lack of training, lack of resources, and a perception of limited utility. 24 The consequences of asthma misdiagnosis include increased medication costs, unwanted medication side-effects and missed opportunities to control disease earlier 28 End-users are seeking research on new ways to diagnosis asthma, better co-testing and diagnosis of important comorbidities (allergies and vocal cord dysfunction). End-users also called for research to develop personalized medication options to suit different types of people and their lifestyles and better information on the side-effects of medications and how to manage them.

Managing asthma attacks
Acute asthma attacks are common in asthma and are a major source of concern for clinicians as they can lead to rapid lung function decline or even death. 30,31 End-users called for research to improve; recognition of early warning signs of acute asthma exacerbations, and skills in improved understanding of how to treat asthma emergencies.

Severe asthma
Whilst only 3%-10% of people with asthma have severe asthma, 32 it appeared in the top 10 research priorities across the three workshops. People with severe asthma experience frequent symptoms and attacks, as well as major psychological and financial burdens. 33,34 Better understanding of the features of severe asthma, its causes and the relationship between severe asthma and emotional and cognitive changes were called for by end-users.
The National Asthma Research Agenda is an example of how a priority setting partnership like that modelled by the James Lind Alliance can be used to derive priority research issues from among research end-users and inform future research directions. We present priority themes from among the data collected, analysed and workshopped, where each theme represents a program of research containing specific focused questions. Other similar exercises have chosen to report single specific questions. 9,35 Many themes and questions prioritized by end-users also reflect priorities of current and recent past asthma researchers in Australia and internationally. These include asthma remission, [17][18][19] and asthma, 20 asthma care and self-management 24,25 and asthma diagnosis 30 which provides reassurance that the agenda and priorities are valid.
The final agenda is a strong one with a mix of themes whose areas of focus align with significant bodies of preexisting research (asthma in children, COVID 19 and asthma, asthma care and self-management), as well as some themes which arguably have been under-emphasized in past 20 years (asthma attacks, diagnosis, causes/prevention, mental health, ageing and comorbidities).
The NAS called for an agenda to guide asthma research, and the national asthma research agenda project has been supported by a range of institutions and researchers in Australia. To this end, it was judged that this national asthma research agenda lends itself to nuanced and tailored application by these institutions, whereas providing specific questions alone may have been narrow and prohibitive for them. Asthma Australia is currently working on this very outcome, which includes extracting the priorities relevant to its role, strategy and ambitions and refining the specific questions against these priorities. In essence, this process takes the priority setting method to its recommended translated end.
The results and process of this prioritization exercise should serve as a call for action to researchers and healthcare professionals to take account of end-user perspectives on what is significant and may be impactful. Dissemination to and engagement with researchers/policymakers, healthcare organizations and external funders can assist in planning future research targeted to areas of high priority for end-users in Australia, bridging the evidence/practice gap identified in the NAS. Developing research questions aligned to the key research themes will be important to ensure that the end-users' perspectives are acknowledged in future asthma research and research is meaningfully guided by their needs.
The strengths of the study include the large sample size and the use of an established and validated process. The key strength of the methodology used is that the outcomes are achieved through a fair, transparent method that is based on robust values and process integrity and involves an equal partnership of patients, carers, healthcare professionals and policymakers. The end-user voice was emphasized at each stage in the project and included ensuring they; were involved in the project governance (in the steering group), were the exclusive audience for the survey, were represented on both the reference groups and ambassador groups, and represented in the composition of the consensus workshops. Given the strong adherence to these values and process, and the enormous amount of information analysed, we believe that the conclusions of this study are valid. Finally, the strong representation of clinicians in the sample size (n = 52, 8.7%) is considered a strength of this study, given the number of clinicians in Australia compared to people with asthma is approximately 3.7%. 36 The limitations of the study include the weak representativeness of the participants to all asthma research endusers. The majority of our participants (77%) were female aged 45-74 limiting generalisability of our results. Second, a low proportion of participants with diverse backgrounds was recorded. Despite active efforts to recruit participants from culturally and linguistically diverse backgrounds, we were less successful than we hoped to be. Third, as our survey was advertised on the websites of various partner organizations and individuals were not targeted, a response rate to the survey cannot be calculated. Fourth, the underrepresentation of young people with asthma was also noted. However, despite being underrepresented the composition of the third workshop was exclusively parents of young people with asthma, which, whilst small in numbers, gave them significant voice to complement the other two workshops.
The wording of the online survey might have influenced participants' responses given the survey materials included examples of what 'day to day limitations caused by asthma' may include. The limited time and the online nature of the workshop might have impacted the engagement of endusers and their ability to deeply assimilate and respond to the substantial content. This risk was foreseen however, and the steering group mitigated it by the distribution of comprehensive pre-reading materials, which included videorecorded instructions. Risk mitigation also included the leadership of an experienced facilitator expert in James Lind Alliance Priority Setting Partnership methods at the workshop who has three decades of expertise working with such processes.
In conclusion, the Priority Setting Partnership approach is an effective way to establish the research priorities of the people who actually use the research outcomes, to address the documented mismatch in research prioritization between the research community and the end-users of research. 4,37 This project successfully adapted a priority setting exercise to an online environment in order to manage issues of geographic representation and infection risks. These novel data can be used to inform planning for future research aimed to meet the needs of asthma end-users.