Asthma patients in Saudi Arabia - preferences, health beliefs and experiences that shape asthma management

The experience of shared decision-making for people with asthma: A systematic review and metasynthesis of qualitative studies

OBJECTIVES

To identify, describe and synthesise the views and experiences of adults living with asthma regarding shared decision-making (SDM) in the existing qualitative literature METHODS: We conducted a comprehensive search of 10 databases (list databases) from inception until September 2023. Screening was performed according to inclusion criteria. Tools from the Joanna Briggs lnstitute were utilised for the purposes of data extraction and synthesis in this study. The data extraction process in this study employed the Capability, Opportunity and Motivation Model of Behaviour (COM-B model) as a framework, and a pragmatic meta-aggregative approach was employed to synthesise the collected results.

RESULTS

Nineteen studies were included in the metasynthesis. Three synthesised themes were identified: the capability of people living with asthma, the opportunities of people living with asthma in SDM, and the motivation of the people living with asthma in SDM.

CONCLUSIONS

We have identified specific factors influencing people living with asthma engaging in SDM. The findings of this study can serve as a basis for the implementation of SDM in people living with asthma and provide insights for the development of their SDM training programs. The ConQual score for the synthesised findings was rated as low. To enhance confidence, future studies should address dependability and credibility factors.

PRACTICE IMPLICATIONS

This review contemplates the implementation of SDM from the perspective of people living with asthma, with the aim of providing patient-centred services for them. The results of this review can benefit the implementation of SDM and facilitate information sharing. It offers guidance for SDM skills training among adults living with asthma, fosters a better doctor-patient relationship and facilitates consensus in treatment decisions, thereby enabling personalised and tailored medical care.

PATIENT OR PUBLIC CONTRIBUTION

Three nursing graduate students participated in the data extraction and integration process, with two students having extensive clinical experience that provided valuable insights for the integration.

Perception of burden of oral and inhaled corticosteroid adverse effects on asthma-specific quality of life

BACKGROUND

A multistakeholder core outcome set created for asthma trials showed that asthma-specific quality of life (QoL) was a critically meaningful outcome. However, the definition and measurement methods were undetermined. The adverse effects (AEs) of corticosteroids may be a vital clinical trial outcome. Nevertheless, the AE burden from the patient perspective has not yet been elucidated in an asthma population.

OBJECTIVE

To characterize patient burden of AEs in oral (OCS) and inhaled corticosteroids (ICS) and how this relates to QoL within an asthma population.

METHODS

We used a convergent parallel mixed-methods design with quantitative surveys of known ICS and OCS AEs that were distributed through the Allergy & Asthma Network database, social channels, and the Asthma UK newsletter. Participants rated the AEs that were (1) most burdensome and (2) most desired to be eliminated. Qualitative interviews and focus groups were performed to better understand patient views on barriers reported in the quantitative data, and to identify patient-important barriers that were not a part of the quantitative survey.

RESULTS

The 3 most burdensome AEs for OCS were bone mineral density, infectious complications, and weight gain, whereas weight gain was the most desired to be eliminated. The 3 most burdensome AEs for ICS were pneumonia, hoarse voice, and oral thrush, with concordant results for the most desired to be eliminated. In the focus groups, OCS AEs were concordant with quantitative findings. Focus groups identified unmeasured psychosocial effects, such as embarrassment.

CONCLUSION

The most burdensome AEs may not be those that would cause patients to stop therapy. Furthermore, qualitative focus groups suggest a psychosocial burden associated with ICS, which needs further investigation.

Stress as a possible cause of a high incidence of hypertension and diabetes and a low incidence of asthma in the Iraqi population

Hypertension and diabetes represent a significant public health burden worldwide and are significant risk factors for heart disease and stroke. Nevertheless, Iraqi people, in particular, experience higher levels of stress due to political instability and economic issues. The study aimed to investigate the prevalence of common morbidities among Iraqi patients and the possible relationship with exposure to stress. The data was collected from patients (n=500) who attended the health center in Najaf, Iraq, between 25 August 2021 and 30 September 2021. The prevalence of hypertension, diabetes, and asthma among Iraqi people was determined along with patients' awareness and control of these conditions. In addition, patients were asked about their experiences with stress, including the type of stress they encountered. Our findings revealed that nearly 47% of patients involved in this study had hypertension, with the highest percentage in patients over 40. Moreover, the incidence of diabetes was 12%, with the highest incidence in the age group of 40-59. The incidence of asthma was lower in all groups. Data analysis concerning exposure to stress demonstrated that about 60% of patients suffer from a stressful life. We found that the incidence of hypertension and diabetes was high while the incidence of asthma was low. This study also reveals that a considerable number of people were unaware of their hypertension and diabetes. Exposure to daily life stress among Iraqi people may play a role in the observed incidence of these morbidities.

Parents’ Decision Making During Their Child’s Asthma Attack: Qualitative Systematic Review

Objective

To conduct a systematic review and synthesis of qualitative evidence exploring the factors that influence a parent’s decision to seek medical assistance while their child is having an asthma attack.

Methods

Studies were included if they used qualitative methodologies and explored parent or carers’ experience of caring for a child (2 to 12 years) during an acute asthma attack at home or in the community. We searched MEDLINE (OVID interface, 1948 onwards), EMBASE (OVID interface, 1980 onwards) and CINAHL (EBSCO) electronic databases. Quality appraisal was assessed by the Critical Appraisal Skills Program CASP for qualitative research, and the qualitative studies in this review were analyzed by thematic synthesis.

Results

From 4798 identified studies, 17 met the inclusion criteria. Synthesis revealed two distinct processes used by parents to aid their decision to seek medical intervention for their child. The first, past experiences informing future decisions and secondly facilitators that drive parents’ to actively pursue medical help.

Conclusion

This review highlights the importance of providing asthma education that not only focuses on the provision of information on symptoms, triggers, medication, and device use but asthma education that targets parents’ unique experience. Using a family strength approach education can impact parents’ future behavior when deciding to seek medical assistance for their child when experiencing an asthma attack. There was not a specific funding source, which supported this review. This review was registered with PROSPERO Identification Number CRD4201912740.

Perceptions towards childhood asthma and barriers to its management among patients, caregivers and healthcare providers: a qualitative study from Ethiopia

Background

The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia.

Methods

A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach.

Results

The study findings revealed that the children’s reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability.

Conclusions

Low awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients’ and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients’ medication access issues.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01984-2.

Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy

The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.