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Apps LD, Chantrell S, Majd S, Eglinton E, Singh SJ, Murphy AC, Green RH, Hudson N, Bradding P, Evans RA. Enabling Adults With Severe Asthma to Exercise: A Qualitative Examination of the Challenges for Patients and Health Care Professionals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3435-3444.e2. [PMID: 37453572 DOI: 10.1016/j.jaip.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adults living with severe asthma have lower physical activity levels, particularly high-intensity physical activity, compared with their healthy peers. Physical inactivity is associated with increased morbidity and mortality. OBJECTIVE To understand patient and health care professional attitudes toward exercise and physical activity to inform future strategies for the improvement of healthy lifestyle behaviors, including exercise. METHODS Participants recruited from a specialist difficult asthma service were interviewed individually, and health care professionals (HCPs) from primary care, secondary care, and a tertiary center were invited to attend focus groups. Interviews and focus groups were transcribed verbatim. We performed thematic analysis on interviews and focus groups separately, followed by an adapted framework analysis to analyze datasets together. RESULTS Twenty-nine people with severe asthma participated in a semi-structured interview. A total of 51 HCPs took part in eight focus groups across the East Midlands, United Kingdom. Final analysis resulted in three major themes: barriers to exercise and exercise counseling - in which patients and HCPs identified disease and non-disease factors affecting those living with severe asthma; attitudes toward HCP support for exercise - highlighting education needs for HCPs and preference for supervised exercise programs; and areas for system improvement in supporting patients and HCPs - challenges exist across health sectors that limit patient support are described. CONCLUSIONS Patients identified the important role of HCPs in supporting and advising on lifestyle change. Despite a preference for supervised exercise programs, both patient and HCP barriers existed. To meet patients' varied support needs, improved integration of services is required and HCP skills need extending.
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Affiliation(s)
- Lindsay D Apps
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; School of Applied Social Sciences, De Montfort University, Leicester, United Kingdom
| | - Stacey Chantrell
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sally Majd
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester
| | | | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester
| | - Anna C Murphy
- NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Ruth H Green
- NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester
| | - Nicky Hudson
- School of Applied Social Sciences, De Montfort University, Leicester, United Kingdom
| | - Peter Bradding
- NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre-Respiratory Theme, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Science, University of Leicester, Leicester.
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Foster J, Beasley R, Braithwaite I, Harrison T, Holliday M, Pavord I, Reddel H. Perspectives of mild asthma patients on maintenance versus as-needed preventer treatment regimens: a qualitative study. BMJ Open 2022; 12:e048537. [PMID: 35063953 PMCID: PMC8785165 DOI: 10.1136/bmjopen-2020-048537] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES As-needed low-dose combination budesonide-formoterol is recommended by asthma guidelines in many countries as an alternative to maintenance inhaled corticosteroids (ICS) for treatment of mild asthma, but there are few data on patient attitudes toward these regimens. This study explored the comparative implementation experiences and future treatment preferences of mild asthma patients who had experienced these two treatment regimens. SETTING A subgroup of adults randomised to maintenance ICS or as-needed ICS-formoterol in a multinational, 52-week open-label randomised controlled trial (NovelSTART) in mild asthma patients were interviewed to explore their motivations for treatment use during the study and their preferences for future treatment. PARTICIPANTS Semistructured interviews were conducted with 74 participants (Maintenance group: n=39, As-needed group n=35, mean age 38 (range 19-69)) and thematically analysed from transcribed audiorecordings. RESULTS Emergent themes from analysis comprised: 'How much my asthma affects me' (how their asthma's impact affected their self-management motivation); 'What I know about asthma' (limited knowledge impeded appropriate self-management decision making); 'How much effort this treatment regimen involves for me' (treatment complexity and/or difficulty establishing a medication routine impeded implementation, particularly in the Maintenance group); and 'My beliefs about the benefits and risks of this treatment' (patients who considered their treatment as ineffective, eg, limited difference in symptoms relative to salbutamol (both groups) or slower onset of relief (As-needed group) had poor motivation to use the treatment). Due to the simplicity of the as-needed combination strategy, this was the preferred future regimen, even by patients who had not yet tried it. CONCLUSIONS Key patient perspectives on the implementation of preventer treatments for mild asthma included factors relating to perceived asthma burden, disease knowledge, treatment complexity and treatment usefulness or safety. The as-needed budesonide-formoterol regimen was preferred to maintenance ICS treatment in mild asthma though patient education is urgently needed to address implementation motivation. TRIAL REGISTRATION NUMBER ACTRN12615000999538.
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Affiliation(s)
- Juliet Foster
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, New South Wales, Australia
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Tim Harrison
- Nottingham Respiratory Medicine Unit and NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Mark Holliday
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Helen Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, New South Wales, Australia
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Stubbs MA, Clark VL, Cheung MMY, Smith L, Saini B, Yorke J, Majellano EC, Gibson PG, McDonald VM. The Experience of Living with Severe Asthma, Depression and Anxiety: A Qualitative Art-Based Study. J Asthma Allergy 2021; 14:1527-1537. [PMID: 34949926 PMCID: PMC8691197 DOI: 10.2147/jaa.s328104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Severe asthma, depression and anxiety often co-exist and increase disease burden. Currently there are no published studies investigating severe asthma and psychological comorbidity using arts-based methodology. We aimed to (i) illustrate the individual experience of adults living with severe asthma, with and without symptoms of depression and/or anxiety and (ii) to explore common characteristics depicted in artworks between those groups. Patients and Methods A qualitative arts-based study was conducted. Adults with severe asthma were categorised into two groups according to Hospital Anxiety and Depression Scale scores (<8 on either subscale [SA-D/A] (N=15) or (≥8 on one or both subscales [SA+D/A] (N=15). Art thematic analysis was undertaken using a hybrid approach. The Common-Sense Model of Self-Regulation was used to examine frequencies in artworks. Results Participants with severe asthma alone and severe asthma with depression/anxiety were of older age (median 67 and 63 years respectively). There was greater asthma QoL impairment in participants with psychological comorbidity than without (4.7 ± 8.3 versus 5.8 ± 0.85, p=<0.01). Analysis of art works identified three themes: (1) “darkness” depicting misery, isolation and sadness; (2) “impacts” describing physical and social consequences; and (3) “resilience” illustrating acceptance and perseverance of living with all three conditions. Conclusion Art-based research in severe asthma facilitates detailed exploration of intimate and individual experiences. Darkness, impacts and resilience are common themes emerging from artworks. Understanding these experiences may help guide assessment and treatment of psychological comorbidity in the clinic.
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Affiliation(s)
- Michelle A Stubbs
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney Children's Hospital Westmead, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia.,Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Janelle Yorke
- School of Health Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Eleanor C Majellano
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Taqi A, Rowlands G, Rathbone AP. A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100051. [PMID: 35480619 PMCID: PMC9030714 DOI: 10.1016/j.rcsop.2021.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is a common chronic disease worldwide affecting an estimated 300 million people. Pharmacists can play key roles to support optimal health outcomes for patients with asthma. Goffman's Dramaturgical Theory was used in this review to critically examine the literature describing the role of pharmacists in asthma services. Objectives The aim of this review is to identify factors that influence the role of pharmacists in asthma care services. Methods A systematic literature search was conducted of seven electronic databases including: CINAHL, Midline (Ovid), PubMed, Scopus, Web of science, Embase and PsycInfo.). The search was not restricted by language or date of publication. Studies were screened according to inclusion criteria which included much relate to pharmacists, asthma services and include qualitative findings. Data was extracted and thematically synthesised to create demographic, descriptive and analytical findings. Results Eighteen studies were included. The majority of studies were conducted in high income countries, with most of the studies conducted in Australia (n = 10). Semi-structured interview was used as a method for data collection in most studies (n = 11). Evidence indicated pharmacists engaged in asthma services positively and wanted to expand their roles in patient care. However, literature reported patients' attitudes and health-system factors such as remuneration, as well as inter-professional collaboration and expected low levels of knowledge and skills of pharmacists were barriers to implementation of pharmacy-led asthma care. Analytical findings suggest that pharmacists' involvement in asthma care services were influenced by patients' and healthcare professionals' expectations which were juxtaposed with pharmacists' own self-perceived identity. Conclusions This review demonstrates pharmacists self-identified as being capable and equipped with appropriate knowledge and skills, however the expectations of patients and other healthcare professionals prohibited their involvement in delivering asthma care services.
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Richards HL, Sweeney P, Corscadden R, Carr C, Rukundo A, Fitzgerald J, O'Connor C, Fortune DG. "Picture this"- Patients' Drawings of Non-Muscle Invasive Bladder Cancer: A Novel Method to Help Understand How Patients Perceive Their Condition. Bladder Cancer 2021; 7:149-159. [PMID: 38994531 PMCID: PMC11181761 DOI: 10.3233/blc-201528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of data regarding patient experiences of living with non-muscle-invasive bladder cancer (NMIBC). OBJECTIVES To investigate patients' beliefs about NMIBC utilising both a well-established verbal/linguistic method, the Brief Illness Perception Questionnaire (B-IPQ) in addition to a novel visual/perceptual method, that is, asking patients to draw their bladder as it is now and as they perceive it will be in the future. METHODS Cross-sectional study of patients with NMIBC. Patients completed: (i) the B-IPQ, and (ii) 2 drawings of their bladder: as they perceived it currently and as they perceived it would look in 5 years' time. RESULTS A total of 118 patients completed the B-IPQ, of which 96 produced 2 bladder drawings. Forty-seven per cent of patients depicted no change in their bladder across time, 35% depicted improvements, while 18% drew their NMIBC as deteriorating between the two time points. Patients who drew their NMIBC worsening over time reported significantly stronger beliefs in the severity of current consequences from their NMIBC (F(2,94) = 9.07, p < 0.001, m = 5.68, 95% CI 4.38-6.88) and greater current concerns about their NMIBC (F(2,94) = 6.17, p < 0.01, m = 7.06, 95% CI 5.47-8.66). This was unrelated to cancer grade, cancer stage, treatment or demographic variables. CONCLUSION This is the first study to explore beliefs about NMIBC in a sample of patients with NMIBC attending routine clinics using both a well-established and a novel method of assessing patients' perceptions. Results highlight the usefulness of a simple non-verbal technique, in identifying patients' concerns about the condition. Almost one fifth of patients with NMIBC may experience significant concerns about the worsening of their condition, which appear to be independent of demographic, histopathological, and treatment related variables. Further exploration of the psychological concerns of individuals with NMIBC is required in order to appropriately plan for needs led multidisciplinary approach in their care.
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Affiliation(s)
- Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Paul Sweeney
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Rebekah Corscadden
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Chelsea Carr
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Aphie Rukundo
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Jill Fitzgerald
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
| | - Charles O'Connor
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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Schindel TJ, Hughes CA, Makhinova T, Daniels JS. Drawing out experience: Arts-informed qualitative research exploring public perceptions of community pharmacy services. Res Social Adm Pharm 2021; 18:2200-2212. [PMID: 33827755 DOI: 10.1016/j.sapharm.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
In many countries around the world, people go to community pharmacies to receive primary health care services. Awareness of public views and experiences may help to identify opportunities for greater uptake of primary health care services provided by pharmacists and ways to improve care. Arts-informed research offers the possibility to provide additional insights into public perceptions of community pharmacy services. The purpose of this exploratory study is to describe the process and results of an arts-informed research project using an adapted version of the draw and write technique in combination with focus group interviews to explore public perceptions of community pharmacy services. The draw and write technique was introduced as an introductory activity to evoke a visual expression of participants' perceptions and experiences with community pharmacy services. Participants were invited to answer the question, "What do community pharmacy services mean to you?" in the form of a drawing and words. They were then prompted to discuss their drawings in a focus group interview. This approach resulted in rich visual and textual data. Analysis consisted of a combination of manual sorting of the visual data and examination of the focus group interview data that were transcribed verbatim, anonymized, and analyzed using an inductive comparative approach. NVIVO version 12 software was used to code and manage all data. Use of the draw and write technique elicited initial, fresh perspectives about community pharmacy services prior to discussions with participants in the focus group interviews. This approach allowed researchers to access a diverse range of experiences and perspectives.
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Affiliation(s)
- Theresa J Schindel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-35 Medical Sciences Building, 8613 - 114 Street NW, Edmonton, Alberta, T6G 2H7, Canada.
| | - Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-35 Medical Sciences Building, 8613 - 114 Street NW, Edmonton, Alberta, T6G 2H7, Canada.
| | - Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-35 Medical Sciences Building, 8613 - 114 Street NW, Edmonton, Alberta, T6G 2H7, Canada.
| | - Jason S Daniels
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11404 - 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
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Cheung MMY, Saini B, Smith L. Integrating drawings into health curricula: university educators' perspectives. MEDICAL HUMANITIES 2020; 46:394-402. [PMID: 31826925 DOI: 10.1136/medhum-2019-011775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
The literature has identified promising findings regarding the application of arts-based initiatives to enhance healthcare professional (HCP) training. Research shows that drawings offer a window into the authentic, insider view of health and illness, with potential to be a platform for healthcare student and HCP learning. In addition, drawings may also have a place in health communication. Our previous work provides support for the educational application of patients' drawings in bringing HCPs closer to the patient's lived experience. Subsequently, this study aimed to explore university educators' opinions regarding the implementation of drawings as an educational tool for higher education healthcare students. The objective of this study was to explore pathways for using drawings as an art form in an educational context, and provide recommendations for developing curricula and resources for further evaluation. Findings from focus group interviews with nine university educators revealed support for the use of drawings as a novel medium as they offer rich insights into the patient's perspective while encouraging creative and critical thinking. Key perceived benefits were that drawings foster student appreciation of (1) the holistic impact of illness, (2) the importance of patients' priorities and (3) the value of learning from the patient. Patients' drawings of their experiences would offer needed opportunities for students to explicitly reflect about the 'person' holistically rather than view the patient as a 'biomedical problem'. Shifting students' perspectives and possible assumptions to be better aligned with and appreciative of the patient's experiences was noted as central to adopting a person-centred approach to healthcare practice. Our findings suggest that incorporating drawings, or indeed other art forms, as educational tools would be a valuable addition to the health curricula.
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Affiliation(s)
- Melissa Mei Yin Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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