Lay Experiences and Concerns with Asthma: DISCUSSION

Posted by James

Patient experiences identified in these group discussions highlighted areas for improvement in the delivery of asthma education and medical care that are community-oriented and enmeshed with day-to-day living. The discussions revealed a need for patient education that integrates perceptions of illness, concerns about potential medication side effects, the impact of lifestyle adjustments on quality of life, and recognition of and response to asthma symptoms. Workshop participants expressed a desire to learn more about managing their [or their child(ren)'s] asthma. They demonstrated knowledge regarding asthma triggers and the medications needed to control symptoms but were challenged to modify their way of life to avoid triggers or maintain a medication regimen. They creatively crafted ways to manage their asthma that did not entirely compromise their quality of life. Some of their coping strategies also countered the biomedical management model for asthma.

Recent exploratory qualitative studies have also identified similar patients’ needs for asthma education. These educational needs included but were not limited to: medication side effects, triggers of asthma attacks, lifestyle concerns and control of symptoms. In addition, Davis et al. also found that confusion with infection was the most common diagnostic problem identified in managing asthma among providers and patients who participated in a focus group to identify educational needs of providers. Others also noted the importance of addressing patients’ worries and perceived threats of asthma, which are part of their lay definition of asthma, in their education and counseling.

This study highlights a disconnect between the lay and biomedical approaches to asthma, identifying a need for better communication between patient and physician in a disenfranchised minority community. This disconnect is similarly recognized by providers who identified a need for bilingual education for families and healthcare provider training to deliver socio-culturally appropriate care to Latinos living in the inner city as essential to improving quality of asthma care. Similarly, “an educational dialog founded on open communication between clinician and patient” that elicits patient perceptions, worries, social support and cultural frameworks is recognized as necessary for successful partnerships in asthma care. The National Asthma Education and Prevention Program has emphasized the need for clinicians to establish “partnerships” with their patients to facilitate better asthma outcomes that would require bridging the experiential and professional discourses.

Educational interventions that combine the biomedical and lay models of care have shown effectiveness. For example, an intervention that included a peer leader in combination with a nurse and physician education improved asthma care. Another intervention that involved a home treatment plan with provider follow-up was also found to be cost effective in improving outcomes, such as decreases in clinic visits and use of oral anti-inflammatory drugs.

Although the experiences noted in this Puerto Rican sample are not unique, the findings support the overall need for education in a personal and sociocultural context. These community workshops were limited in size and scope and may not be gener-alizable to other similar communities. No data was collected to provide demographic characteristics of the workshop participants. In addition, the workshops were conducted in February and March in Buffalo. The seasonal nature of asthma may have biased some of the responses. However, the information gathered here raises important questions about the delivery of patient education and can be used as a baseline to gather more in-depth information on how interventions may be structured to better improve office-based asthma education and patient management of asthma.

In order to bridge the gap between the lay and biomedical management models for asthma, healthcare providers should be trained to understand the patients’ perception of disease, with an emphasis on the cultural background and socioeconomic situation of the patient. Providers must ask about patient’s perceived indoor asthma triggers and reinforce effective and creative strategies that the family is already using to reduce these exposures. Having knowledge of community programs could help offset the cost and encourage implementation of other remediations. There is a need for better follow-up with primary care providers after an emergency department visit for an asthma episode to assess the context that resulted in the visit. Patients need to have continued education on medication administration with discussion on strategies to lessen side effects or determine if other medications are necessary. Asthma-related limitations vary among individuals. Alternative treatments to improve quality of life should be addressed in response to an individual’s limitations, with an emphasis on practicality. Providers should encourage positive approaches already being practiced, elicit and dispel mispercep-tions, and identify other alternative practices that improve quality of life that complement the biomedical management model. montelukast asthma

Considering the competing demands of primary care providers, creative ways to incorporate in-depth education are needed in the office setting. For example, a staff member may become a certified asthma educator to assist the provider in undertaking personalized asthma education. The National Cooperative Inner-City Asthma Study found that a Masters-in-social-work-trained asthma counselor was effective in conducting a personalized asthma educational intervention among low-income children. This model can be incorporated into the primary care setting. Inter­ventions within the primary care setting that improve patient-physician communication and processes for extending educational efforts to other office staff can be tested within primary care settings serving minority patients. Through improved patient-physician communication and the extension of educational efforts within the primary care setting, a more comprehensive medical management model may evolve.