Elsevier

Patient Education and Counseling

Volume 48, Issue 2, October–November 2002, Pages 189-194
Patient Education and Counseling

Perceptions of asthma in South Asians and their views on educational materials and self-management plans: a qualitative study

https://doi.org/10.1016/S0738-3991(02)00033-2Get rights and content

Abstract

Asians with asthma have higher hospital admission rates than whites without any evidence of increased asthma severity. There is limited information as to whether these differences are due to language or communication difficulties, variable knowledge and cultural attitudes to asthma or deficiencies of medical care. A qualitative study with 60 participants (12 participants with asthma for semi-structured interviews and 48 participants for focus groups) was designed to explore knowledge about asthma, attitudes, perceptions, health beliefs and health needs of those from Pakistan and India (South Asians). Overall, most of the patients with asthma were aware of the symptoms and trigger factors of asthma and were well informed about the ‘reliever’ and ‘preventer’ properties of their inhalers. They were also well informed about alternative/complementary therapies and were willing to try them should the treatment provided by their general practitioner (GP) fail to resolve their symptoms. Most were dissatisfied with the asthma care provided by their GPs e.g. delays in making the diagnosis and deficiencies in providing both verbal and written information on asthma. There was lack of awareness about self-management plans although when explained, the concept of self management was well received and there was approval for the concept of written action plans. All the focus group participants seemed to know something about asthma and amongst those with the condition (or with relatives with the condition), knowledge of the disease and its treatment seemed to be good. It was concluded that improved dissemination of written and verbal information on all aspects of asthma and increased awareness, training and support for adoption of written self-management (action) plans is needed to provide a more efficient and effective service for South Asian patients with asthma.

Introduction

Studies [1], [2], [3], [4], [5] have demonstrated that Asians with asthma have a higher hospitalisation rate than whites without any evidence of increased asthma severity or high re-admission rates [2]. Possible reasons for this are poor asthma education, language barriers or poor compliance with medication. Since successful management of asthma requires attention not just to observable behaviour but also to the underlying attitudes and beliefs which drive that behaviour, a small scale qualitative study was undertaken to explore the experience of asthma in people of Pakistani and Indian background living in East London.

The major aims of this study were:

  • To explore knowledge, attitudes, perceptions, health beliefs and health needs of those originally from India and Pakistan.

  • To explore attitudes and acceptability of self management plans.

Section snippets

Study population

The London Boroughs of Redbridge and Waltham Forest have a population of approximately 0.45 million. Information from the 1991 office of population censuses and surveys showed that ethnic minority groups, whether born in the UK or not, make up 28% of the population and they are mainly of Indian subcontinent origin or Black African Caribbeans.

Recruitment

After gaining approval from the local research ethics committee, an interpreting service was used to translate the English version of the invitation

The nature of asthma

All the participants were familiar that asthma was a condition associated with cough, wheeze and difficulty breathing. Some of the participants said “my chest makes a noise” rather than use the word wheeze. Tiredness, chest pain, chest tightness and hyperventilation were also mentioned as symptoms associated with asthma with one participant saying he produced large amounts of phlegm.

With regards to what was happening in the body, most participants said the tubes in the lungs blocked up but

Discussion

Despite not being satisfied with the asthma care provided by their GPs, all the participants had very good general knowledge of the triggers associated with asthma and were aware of the symptoms and episodic nature of asthma. This is not surprising because there has been increased levels of publicity around asthma in recent years particularly through the media. Since 1990 nurse led asthma clinics have been established in UK primary care and it appears from this study that adequate information

Conclusions

Despite limitations and the small scale nature of this qualitative study, the following important conclusions can be drawn:

  • All participants with asthma were aware that it is a condition associated with cough, wheeze, difficulty breathing and the majority were aware of trigger factors for asthma.

  • The majority of the patients with asthma were aware of the difference between ‘reliever’ and ‘preventer’ inhalers, although some stopped using the inhaled steroids because they felt they were

Acknowledgements

We are very grateful to Sue Collett and Denise Bentley for their considerable help with this project and for acting as reporters in the focus groups. The cost of the study was borne by the Department of Health and we acknowledge with thanks the assistance of Ms. Veena Bahl.

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