Barriers and Facilitators to Healthy Physical Activity in Asthma Patients

Preliminary evidence indicates that asthma patients limit exercise and healthy lifestyle activities to avoid respiratory symptoms. This self-imposed decrease in activity, even among those with mild disease, may predispose to long-term general health risks. The objectives of this qualitative study were to determine patients' views about exercise and lifestyle activities and to determine if these views varied depending on asthma characteristics. During in-person interviews, 60 patients were asked open-ended questions about asthma and perceived barriers and facilitators to exercise and lifestyle activities, particularly walking. Responses were coded and corroborated by independent investigators and then compared according to asthma severity, knowledge, self-efficacy, and attitudes. Although most patients acknowledged the importance of exercise, many either limited or did not participate in exercise because of asthma and other conditions. Patients cited both internal and external barriers to exercise, such as lack of motivation, time constraints, and extreme weather affecting asthma. Patients identified multiple facilitators, such as social support and the desire to be healthy. Lifestyle activities were preferred over formal exercise regimens. Patients with more severe disease were more likely to believe that exercise was not good for asthma. Patients with less knowledge, less self-efficacy, and worse attitudes toward asthma also were more likely to have negative perspectives about exercise. In conclusion, for many patients, asthma is a deterrent to physical activity and predisposes to inactivity. Developing interventions to foster prudent lifestyle activities and exercise among asthma patients should be a priority to decrease long-term health risks.

Designing an illustrated patient satisfaction instrument for low-literacy populations

Up to 25% of adults in the United States have difficulty with everyday reading tasks. As patients, adults with low literacy may not be able to complete many self-administered written questionnaires, which often are used to obtain information from patients and to gauge their satisfaction with care. We developed an illustrated version of a patient satisfaction instrument used by the Veterans Health Administration. This paper describes the extensive design process used to develop, pilot-test, and revise this 63-item illustrated instrument. A total of 438 patients were interviewed over a 1-year period to obtain feedback on illustrations, with at least 15 people viewing and commenting on each picture and revision. All pictures were revised, with the majority revised at least 4 times. We report on this iterative design process as well as on lessons we learned in illustrating questions for low-literacy populations.