Psychosocial working conditions and the subjective prognosis of gainful employment among employees with asthma: a cross-sectional study

Can an educational intervention in the context of inpatient pulmonary rehabilitation improve asthma self-management at work? A study protocol of a randomized controlled trial

BACKGROUND

Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness.

METHODS

Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module "Asthma and Work" while the control group will participate in a program on " Eating behaviour" (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance.

DISCUSSION

Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave.

TRIAL REGISTRATION

German Clinical Trials Register (ID: DRKS00031843).

Implementing the Patient Needs in Asthma Treatment (NEAT) questionnaire in routine care: a qualitative study among patients and health professionals

BACKGROUND

Many patients with asthma report unmet health care needs. The Patient Needs in Asthma Treatment (NEAT) questionnaire is a validated instrument to quantify these unmet needs. We explored how health professionals evaluated the instrument's utility as well as patients' and professionals' perspectives of how NEAT could be incorporated into routine clinical practice.

METHODS

Qualitative interviews were conducted by telephone between February and September 2021 with 19 patients with asthma and 21 health professionals (i.e., general practitioners, pneumologists, health professionals in pulmonary rehabilitation, and medical assistants). Interview recordings were transcribed verbatim and content-analyzed using both deductive and inductive approaches using MAXQDA.

RESULTS

Health professionals could see the potential value of using NEAT to inform clinical decisions. However, health professionals tended to be skeptical towards the routine use of NEAT in outpatient settings, mainly due to a lack of time. Implementation of NEAT was seen as more valuable in the context of patient education (i.e., in Disease Management Programs [DMPs] or pulmonary rehabilitation) by patients and health professionals alike, because it offered greater opportunities to address any unmet needs identified. Both patients and health professionals considered it more useful to use the questionnaire for the first time some time after the initial diagnosis has been made (e.g., when the treatment regime is found rather than at time of initial diagnosis). In the context of DMPs and pulmonary rehabilitation, NEAT could be used twice, i.e., before and after patient education to support patient-centered planning and evaluation.

CONCLUSION

Both patients and health professionals consider the use of the NEAT, in particular in educational programs (i.e., during DMPs or pulmonary rehabilitation), as feasible and useful. There is now a need to undertake a feasibility trial in routine care.

Asthma self-management at work, asthma morbidity, and the subjective prognosis of gainful employment - the role of work engagement and overcommitment: a cross-sectional study

OBJECTIVE

Work engagement is considered a constructive and satisfying state of mind promoting well-being, whereas overcommitment contributes to ill-health. We investigated if these psychosocial factors are related to asthma self-management at the workplace (i.e. physical activity, trigger avoidance, acute symptom management, communication), asthma control, asthma-specific quality of life, and the subjective prognosis of gainful employment among employees with asthma.

METHODS

Questionnaires were distributed in three pulmonary rehabilitation clinics (10/2017-05/2018) in Germany. Work engagement was measured by three items from the Copenhagen Psychosocial Questionnaire and overcommitment by six items from the effort-reward imbalance questionnaire. Asthma self-management was mainly assessed by self-developed items, asthma morbidity by the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire, and the subjective prognosis of gainful employment by a validated three-item scale. After dichotomization of all variables we ran Poisson regression analyses to calculate multivariable prevalence ratios with 95% confidence intervals.

RESULTS

The sample comprised 221 individuals with asthma. Low work engagement was related to physical inactivity. Low work engagement and high overcommitment were associated with inadequate trigger avoidance and acute symptom management, reduced asthma-specific quality of life, and a poor prognosis of gainful employment. No relationships were observed with communication or asthma control.

CONCLUSIONS

Our findings highlight the potential contribution of high levels of work engagement to adequate asthma self-management, good quality of life, and a positive subjective prognosis of gainful employment among employees with asthma. Overcommitment shows associations with those outcomes in the opposite direction, which suggests a detrimental role in asthma.