Lay Experiences and Concerns with Asthma

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INTRODUCTION

Asthma is a chronic disease that can be managed with appropriate medication and education. Some disparities in prevalence and related morbidity have been identified among minority populations, particularly children. For example, Puerto Rican children have been documented to have higher prevalence rates of asthma compared to African Americans and non-Hispanic whites. Specifically, data from the National Health Interview Survey found that 83% of Puerto Rican children who reported wheezing in the past year were diagnosed with asthma compared to 71% of African American and 57% of non-Hispanic white children. While asthma prevalence among Hispanic adults in 2002 was lower than among non-Hispanic white adults (5% compared to 7.6%, respectively), prevalence in Puerto Rico was higher than in the 50 United States, and U.S. territories. A study by Ledogar et al. also found that Puerto Ricans had higher rates of asthma than other Hispanic subgroups. Similarly, Puerto Ricans had higher asthma mortality rates compared to African Americans and non-Hispanic whites (40.9 per million, 38.1 per million, and 14.7 per million, respectively. Puerto Ricans also had higher asthma mortality rates than other Hispanic subgroups. Hispanic adults with asthma were more likely than non-Hispanic white adults to present to the emergency room (26%) and 14.5%>, respectively), to have asthma-related urgent care visits (36.9% and 25.8%), to have sleep difficulty (64.7% and 47.4) and to have activity limitations (40.4 and 23.6).

The National Heart, Lung and Blood Institute’s asthma guidelines encourage patient education to improve management and thus improve outcomes. The guidelines recommend a continuum of educational opportunities that are supported by all members of the healthcare team, with a focus on self-management. Education should be offered in a manner appropriate to the patient’s culture, age and socioeconomic status. The preparation of a written asthma action plan is one educational component that requires good provider-patient communication in order to devise a strategy for managing asthma that is medically appropriate as well as understandable, acceptable and practical to the patient.

The translation of patient education into a culturally appropriate model is challenging. It purports the amalgamation of two distinct idioms: the language of the biomedical professional developed in medical school, and the lay person’s, which is molded by lived experience. Zayas et al., for example, highlighted the need to bridge these two idioms, having demonstrated how members of a predominately Puerto Rican patient population with low levels of education characterize asthma according to the acute illness model in terms of symptoms and threats of illness rather than as a chronic biomedical disease. Such disconnect can hamper the patient’s assimilation of the practical knowledge transmitted during office-based asthma education and thus the implementation of the prescribed asthma management plan. By better connecting these two distinct world views, the clinician-patient relationship and patient self-management strategies may improve and, in turn, alleviate the burden of asthma and prove cost-effective. buy zyrtec

The purpose of this study is to describe patients’ experiences and concerns with asthma that challenge disease management in an urban Puerto Rican community in Buffalo, NY, with a high burden of asthma. Specifically, the main study question was: “What are the common perceptions of and concerns with asthma that could affect proper self-management in this population?” Understanding these experiences may help care providers to better deliver asthma education that can be readily incorporated into the patients’ everyday life.