Maureen George

Asthma Numeracy Skill and Health Literacy

To assess understanding of numerical concepts in asthma self-management instructions, a 4-item Asthma Numeracy Questionnaire (ANQ) was developed and read to 73 adults with persistent asthma. Participants completed the Short Test of Functional Health Literacy in Adults (STOFHLA), 12(16%) answered all 4 numeracy items correctly; 6(8%) answered none correctly. Participants were least likely to understand items involving risk and percentages. Low numeracy but not STOFHLA score was associated with a history of hospitalization for asthma. At higher STOFHLA levels there was a wide range of the total number of correct numeracy responses. Numeracy is a unique and important component of health literacy.

Perceptions of barriers and facilitators: Self-management decisions by older adolescents and adults with CF

BACKGROUND Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. METHODS Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. RESULTS Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). CONCLUSIONS Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.

Clearing Clinical Barriers: Enhancing Social Support Using a Patient Navigator for Asthma Care

Background. Patients with moderate or severe asthma, particularly those who are minority or poor, often encounter significant personal, clinical practice, and health system barriers to accessing care. Objective. To explore the ideas of patients and providers for potentially feasible, individualized, cost-effective ways to reduce obstacles to care by providing social support using a patient advocate or navigator. Methods. The authors conducted four focus groups of adults with moderate or severe asthma. Participants were recruited from clinics serving low-income and minority urban neighborhoods. Data from these patient focus groups were shared with two additional focus groups, one of nurses and one of physicians. Researchers independently coded and agreed upon themes from all focus groups, which were categorized by types of social support: instrumental (physical aid), informational (educational), emotional (empathizing), validation (comparisons to others). Results. Patients and providers agreed that a patient navigator could help patients manage asthma by giving social support. Both groups found instrumental and informational support most important. However, patients desired more instrumental help whereas providers focused on informational support. Physicians stressed review of medical information whereas patients wanted information to complete administrative tasks. Providers and patients agreed that the patient navigators role in asthma would need to address both short-term care of exacerbations and enhance long-term chronic self-management by working with practice personnel. Conclusions. Along with medical information, there is a need for providers to connect patients to instrumental support relevant to acute and long-term asthma-self-management.

Women and Lung Disease. Sex Differences and Global Health Disparities

There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low- to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided.

A Systematic Review of Complementary and Alternative Medicine for Asthma Self- management

This article is a systematic review of complementary and alternative medicine use for pediatric and adult asthma self-management. The aim of the review was to summarize the existing body of research regarding the types and patterns of, adverse events and risky behaviors associated with, and patient-provider communication about complementary therapies in asthma. This evidence serves as the basis for a series of recommendations in support of patient-centered care, which addresses both patient preferences for integrated treatment and patient safety.

The Effects of Health Literacy on Asthma Self-management

The purpose of this inquiry was to explore, analyze, and synthesize the current research findings regarding the role of low health literacy in asthma self-management. The authors obtained relevant articles by conducting a search in the following databases: Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE (Ovid), PubMed Plus, and Google Scholar. Search terms included combinations of asthma, peak flow, inhaler, asthma action plan, management, and literacy. The search was restricted to English-language publications and to studies recently conducted in the United States. Ten articles were retained that met these inclusion and exclusion criteria. Taken together, these data indicate that low health literacy is associated with less accurate metered-dose inhaler technique, less use of peak flow meters and asthma action plans, less ability to calculate peak flow zones, higher rates of emergency department visits and hospitalizations for asthma, and less desire to participate in decision making. Low ...

Improving Adherence to Asthma Medications

Adherence is a complex behavior that depends on a patient’s decision-making process in response to health care advice and results in the patient taking none, some, or all of the advice. A variety of factors influence the patient’s decision as to the burden versus the benefit of the recommendation. Adherence reflects the type of disease, its severity, the recommended treatment regimen, and the obstacles to care, as well as the characteristics of the patient and the provider. For patients to successfully integrate health care advice into their daily life, impediments to adherence and negative influences should be identified and minimized. This approach may improve patient acceptance and adherence to the treatment plan.

Changes in clinical conversations when providers are informed of asthma patients' beliefs about medication use and integrative medical therapies

OBJECTIVES To explore whether patients personal beliefs about inhaled corticosteroid (ICS) and integrative medicine (IM) are discussed at routine primary care visits for asthma. BACKGROUND Negative medication beliefs and preferences for IM can be salient barriers to effective asthma self-management. METHOD A qualitative analysis of transcripts from 33 audio-recorded primary care visits using conventional content analysis techniques. RESULTS Four themes emerged when providers had knowledge of patients beliefs: negative ICS beliefs, IM use for asthma, decision-making and healthy lifestyles. Two themes were identified when providers did not have this knowledge: asthma self-management and healthy lifestyles. CONCLUSION When providers had knowledge of their patients IM endorsement or negative ICS beliefs, they initiated conversations about these modifiable beliefs. Without training in IM and in effective communication techniques, it is unlikely that providers will be able to effectively engage in shared decision-making aimed at improving asthma self-management.

Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: an integrative review.

Asthma is the leading cause of pediatric hospital admissions in the United States. In response to the high prevalence of asthma and the variations in care, clinical practice guidelines have been developed and recommend the use of a clinical pathway for inpatient management. This review will examine the effects of a pediatric asthma clinical pathway on inpatient stays, specifically the length of stay (LOS) and cost of inpatient admissions. A literature review was performed to identify original research projects examining the effects of an asthma clinical pathway on inpatient pediatric admissions. Nine studies were found to fit the criteria and are included in this review. These nine studies found consistent evidence that the use of an asthma clinical pathway for inpatient asthma admissions resulted in reduced LOS and cost.

Innovative use of a standardized debriefing guide to assist in the development of a research questionnaire with low literacy demands

Prevalence and impact of low literacy has resulted in greater attention to developing written materials at lower reading levels for both patient education and research. The purpose of this study was to develop and evaluate how well a research questionnaire about self-management preferences, intentionally developed as a tool for individuals with low literacy skills, performed. The investigators created a standardized debriefing guide to evaluate comprehension and ease of instrument completion to accompany the administration of the Conventional and Alternative Management for Asthma (CAMA) instrument. The use of a standardized debriefing guide following cognitive interviewing techniques, allowed for the identification of problematic words, unclear meanings and confusion over scaling despite a deliberate attempt to develop a tool with low literacy demands. Such approaches might be considered critically important to insure the accuracy of patient-reported outcomes when self-administered tools are used to collect research and clinical data.