Abstract
Abstract
Objective
To assess the Knowledge, Attitudes and Practices (KAP) among healthcare professionals in managing patients with coexisting hypertension and bronchial asthma.
Design
A cross-sectional survey. The reporting of this study followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist.
Setting
From 30 March to 15 April 2024 at 66 various level hospitals and community health service centres.
Participants
Physicians and nurses specialising in clinical internal medicine, each with over 2 years of practice and who provided informed consent.
Primary and secondary outcome measures
The demographic characteristics of the healthcare professionals and their KAP towards the Management of Patients with Hypertension and Concurrent Bronchial Asthma were collected using a self-administered questionnaire. The primary outcome was the KAP scores. The secondary outcomes were the factors associated with the KAP scores and how the KAP dimensions interacted among them.
Results
The study involved 586 valid questionnaires collected from participants. Participants’ median KAP scores were as follows: knowledge – 8 (IQR: 6–9), attitude – 31 (29-34) and practice – 41 (36-46) on scales ranging from 0 to 12, 7 to 35 and 12 to 60, respectively. Multivariate logistic regression analysis showed having a Bachelor’s degree or higher education (OR=0.614; 95% CI (0.421, 0.896); p=0.011), and a knowledge score ≥8 (OR=2.130; 95% CI (1.527, 2.973); p<0.001) significantly predicted adherence to recommended practices. Structural equation modelling revealed significant direct effects between knowledge and attitude (β=0.578, p=0.010) and between knowledge and practice (β=0.221, p=0.010). However, the direct link between attitude and practice (β=0.162, p=0.052) and indirect effect of knowledge on practice via attitude (β=0.094, p=0.052) were not statistically significant.
Conclusions
Healthcare professionals exhibited limited knowledge, positive attitudes but suboptimal practices when managing patients with comorbid hypertension and bronchial asthma. It is crucial to develop targeted educational interventions and continuous professional development programmes to improve clinical outcomes in this patient population.
Keywords: Hypertension; Education, Medical; PUBLIC HEALTH
Strengths and limitations of this study.
Large sample size: the study included 586 healthcare professionals, providing a robust dataset for analysis and enhancing the generalizability of the findings.
Diverse settings: conducted across 66 various level hospitals and community health service centres, the study captures a wide range of practices and experiences.
Comprehensive assessment: the use of a detailed, self-administered questionnaire allowed for an in-depth evaluation of Knowledge, Attitudes and Practices among participants.
Self-reported data: the reliance on self-administered questionnaires may introduce response bias, with participants potentially overestimating their knowledge or adherence to recommended practices.
Potential selection bias: participants who provided informed consent and completed the survey might differ in important ways from those who did not participate, possibly affecting the representativeness of the results.
Introduction
Hypertension presents a significant global health issue, characterised by high morbidity rates.1 Concurrently, bronchial asthma, a prevalent chronic respiratory disease, continues to witness a rise in global incidence.2 Epidemiological studies have provided evidence that certain diseases co-occur more frequently than would be expected by chance, indicating potential shared pathogenetic mechanisms.3 Research focusing on patients has revealed a significant comorbidity between bronchial asthma, a chronic respiratory condition and hypertension.4 5 Several factors have been proposed to explain the development of hypertension in patients with asthma. These include diminished lung function, systemic inflammation, dysregulation of smooth muscle tone, vascular remodelling, adverse effects of therapeutic interventions and genetic predispositions.6 However, despite the recognised burden of these comorbid conditions, there is limited research exploring healthcare professionals’ readiness to manage both diseases simultaneously, particularly within the context of developing countries like China. Such a dual challenge underscores the critical need for effective management strategies for patients concurrently dealing with both hypertension and bronchial asthma.
The theoretical framework of Knowledge, Attitudes and Practices (KAP) forms the bedrock of this research. KAP studies are instrumental in understanding how knowledge (cognitive aspect), attitudes (affective aspect) and practices (behavioural aspect) influence health outcomes.7 8 There have been numerous studies focusing on the KAP among healthcare professionals regarding various health issues. For instance, research has identified significant gaps in the knowledge and practices of primary healthcare physicians in Sichuan’s Tibetan areas concerning hypertension management.9 Similarly, surveys have indicated that community pharmacists show inadequacies in educating patients with hypertension.10 This issue becomes even more complex when considering the dual management required for patients suffering from both hypertension and asthma. This insufficiency in knowledge and low awareness can precipitate suboptimal patient care and management strategies, presenting a glaring vulnerability in healthcare delivery.
Despite the pressing need for insights, the notable lack of KAP-focused research on managing hypertension and asthma together highlights the urgent need for targeted investigations to improve healthcare professionals’ knowledge and management practices for these comorbid conditions. This study aims to bridge this gap by examining the KAP of healthcare professionals in this field. By accentuating the significance of this research objective, the study seeks not only to illuminate the current state of healthcare professionals' preparedness but also to catalyse improvements in patient management and outcomes in the realm of comorbid hypertension and asthma.
Materials and methods
Study design
This cross-sectional study was conducted between 30 March and 15 April 2024 at multiple medical centres in the Yellow River Delta region Medical staff. This study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, which has been provided as an online supplemental file at the end of the manuscript.
Study area
This study was conducted within the Huang He River Delta General Medicine Specialist Alliance, a regional medical organisation aimed at promoting general medicine and enhancing medical service quality. The Huang He River Delta General Medicine Specialist Alliance covered four prefecture-level cities and their respective counties (Binzhou, Dongying, Dezhou and Zibo). This alliance involves 66 hospitals and community health service centres.
Study participants
The study was approved by the Ethics Committee of Binzhou Medical University Hospital (KYLL-207). The study included practicing physicians and nurses specialising in clinical internal medicine with over 2 years of experience. Exclusion criteria encompassed healthcare professionals who had resigned, withdrawn during the study, or did not provide informed consent.
Sampling
The sample size required for the questionnaire survey was calculated using the Open Epi-calculator with the specific formula based on this formula to obtain the needed sample size for the survey. Among them:
n: represents the required sample size.
z: the Z statistic for the confidence level, for example, the Z statistic for a 95% confidence level is 1.96 and for a 99% confidence level, it is 2.58.
p: the probability of the option, typically set at 0.5.
e: the sampling error, usually set at 5%. A smaller sampling error results in higher confidence in the conclusions.
The effective recovery rate of the questionnaire was calculated at 80%, so collecting at least 500 valid questionnaires is the minimum sample size required to ensure the credibility of the research results.
Data collection method
The method of convenience sampling was employed to include participants from the Huang He Delta General Practitioner Alliance, which covers 66 hospitals and community health service centres. Research subjects were recruited via the alliance’s WeChat group. Participants could either scan the provided QR code or click on a direct link to access the electronic questionnaire. The anonymous electronic questionnaire was administered through the online platform ‘Survey Star’, developed by Ranstar Technology in Changsha, Hunan, China (https://www.wjx.cn/). Out of the target population of 800 clinical internal medicine, a total of 619 participants submitted complete questionnaires.
Instrument
The questionnaire’s design was guided by pertinent guidelines and literature.11 12 It underwent a preliminary consultation with three specialists (a cardiovascular expert, a respiratory specialist and a general practitioner) to enhance its content validity. A pilot study was conducted with 30 participants (n=30) to refine the questionnaire and ensure its clarity and reliability. Pre-experiment feedback was carried out to further improve the questionnaire and enhance its clarity and reliability. The overall reliability of the questionnaire, as indicated by a Cronbach’s α coefficient of 0.869, reflects its robustness (0.723 for the knowledge dimension, 0.760 for the attitude dimension and 0.871 for the practice dimension).
Structured into four sections—basic information, knowledge, attitude and practice dimensions—the questionnaire offers a comprehensive assessment. The knowledge section comprises 12 questions, scored as 1 for correct and 0 for incorrect or unclear answers, with a total possible score of 0–12. The attitude section includes seven items, scored on a 5-point Likert scale from very positive (5 points) to very negative (1 point), totalling a 7–35 score range. The practice section contains 11 questions, also on a 5-point scale from always (5 points) to never (1 point), leading to a 11–55 range. Achieving scores above 75% of the maximum in each dimension signifies sufficient knowledge, a positive attitude and proactive practice.13
Statistical analysis
In this study, demographic data and dimension scores underwent descriptive analysis, assessing score distribution normality and employing mean and SD for normal distributions or median and IQR for non-normal distributions. Count data were presented as N (%). Score comparisons across different demographics used t-tests for normal, continuous variables and Wilcoxon-Mann-Whitney tests for non-normal data, while ANOVA or Kruskal-Wallis tests were applied based on the data’s adherence to normality and variance homogeneity. Correlation analyses used Pearson or Spearman coefficients depending on normality. The associations between dimension scores and demographic variables were examined using univariate and multivariate regression analyses. The results were categorised by mean or median, depending on normality, with a significance threshold set at p<0.05. Variables with univariate analysis results of p<0.1 or p<0.25 were included in the multivariate logistic regression model. Structural equation modelling (SEM) was employed to examine the interrelationships among the questionnaire dimensions, focusing on the direct and indirect effects of knowledge on practice.
The SEM was evaluated using several fit indices to assess model adequacy. The CMIN/DF (χ2/degree of freedom ratio) measures the relative fit of the model, with an ideal value of less than 3 and an acceptable threshold below 5. The Root Mean Square Error of Approximation (RMSEA) indicates the error of approximation per degree of freedom, where values below 0.05 are considered ideal and those under 0.07 are acceptable. The Goodness-of-Fit Index (GFI), which measures the proportion of variance explained by the model, is deemed ideal when above 0.9 and acceptable when exceeding 0.8. Similarly, the Adjusted Goodness-of-Fit Index (AGFI), an adjusted version of GFI that accounts for model complexity, follows the same interpretation standards.
Patient and public involvement
Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.
Results
Initially, a total of 619 questionnaires were collected for this study, and 33 were excluded based on the following criteria: 10 did not agree to participate in this study and 23 had unreasonable response times (less than 101 s and more than 1110 s), resulting in a total of 586 valid questionnaires. The Cronbach’s α of the formal experimental was 0.885 (the Cronbach’s α of the knowledge dimension was 0.730, the Cronbach’s α of the attitude dimension was 0.795 and the Cronbach’s α of the practice dimension was 0.920); the KMO (Kaiser-Meyer-Olkin) value was 0.897.
Among the healthcare professionals who participated in this study, 283 (48.3%) were above 40 years of age, 398 (67.9%) were females, 424 (72.4%) had a bachelor’s degree or higher, 339 (57.8%) were doctors, 240 (41.0%) had intermediate professional titles, 216 (36.9%) had been working for more than 20 years and 207 (35.3%) were working in tertiary hospitals. The median (25th percentile, 75th percentile) scores of knowledge (possible range: 0–12), attitude (possible range: 7–35) and practice (possible range: 12–60) were 8 (6,9), 31 (29,34) and 41 (36,46), respectively. Participants from respiratory internal medicine had a higher median knowledge score (8 (5.5, 9)) compared with those from cardiovascular internal medicine (7 (5, 9)) and other departments (8 (6 9)), indicating that the department type was associated with differences in knowledge scores (p=0.039). In terms of attitude scores, individuals with senior professional titles had a higher median score (32 (30, 33)) than those with no title (30.5 (28, 35)), junior (31 (28, 34)) or intermediate titles (32 (29, 35)), suggesting that professional title influenced attitude scores (p=0.047). For practice scores, participants working in private clinics had a higher median score (43 (39, 48)) compared with those working in township health centres (41 (36, 44)), community hospitals (42 (38, 44)), secondary hospitals (42 (36, 51)) and tertiary hospitals (40 (34, 45)), reflecting that the workplace type was associated with differences in practice scores (p=0.026) (online supplemental table S1).
The distribution of knowledge dimension showed that the question with the highest proportion of participants choosing the ‘yes’ option was ‘Obesity is not only a major risk factor for asthma and hypertension but also a significant influencing factor in asthma control.’ (K7) with 81.9%. The question with the highest proportion of participants choosing the ‘not sure’ option was ‘Hypertension during pregnancy is related to an increased risk of asthma in offspring.’ (K4) with 50.9%. The question with the highest proportion of participants choosing the ‘no’ option was ‘Decreased lung function in asthma patients is not related to an increase in cardiovascular-related mortality.’ (K2) with 53.8% (table 1).
Table 1. Knowledge dimension of the participants.
| Yes | Not sure | No | |
| 1. Blood pressure levels are associated with the severity of asthma. | 370 (63.1) | 177 (30.2) | 39 (6.7) |
| 2. Decreased lung function in asthma patients is not related to an increase in cardiovascular-related mortality. | 157 (26.8) | 114 (19.5) | 315 (53.8) |
| 3. The complications of combined hypertension and asthma are not related to medication side effects. | 78 (13.3) | 184 (31.4) | 324 (55.3) |
| 4. Hypertension during pregnancy is related to an increased risk of asthma in offspring. | 212 (36.2) | 298 (50.9) | 76 (13.0) |
| 5. Characteristics of asthma combined with hypertension include airway hyperresponsiveness, hypertrophy and hyperplasia of bronchial smooth muscles, structural remodelling and increased mucus secretion, as well as elevated vascular tension and blood pressure. | 466 (79.5) | 108 (18.4) | 12 (2.0) |
| 6. Asthma patients with combined hypertension primarily exhibit late-onset, hormone-insensitive and difficult-to-treat asthma. | 391 (66.7) | 165 (28.2) | 30 (5.1) |
| 7. Obesity is not only a major risk factor for asthma and hypertension but also a significant influencing factor in asthma control. | 480 (81.9) | 94 (16.0) | 12 (2.0) |
| 8. Calcium channel blockers are the preferred drugs for patients with combined hypertension and asthma. | 440 (75.1) | 116 (19.8) | 30 (5.1) |
| 9. Non-selective β-blockers should be avoided in unstable asthma patients. | 447 (76.3) | 112 (19.1) | 27 (4.6) |
| 10. Hypertensive patients using angiotensin-converting enzyme inhibitors may experience cough symptoms but can be used in patients with combined asthma and hypertension. | 366 (62.5) | 140 (23.9) | 80 (13.7) |
| 11. Angiotensin receptor blockers can alleviate asthma symptoms. | 356 (60.8) | 184 (31.4) | 46 (7.8) |
Responses to the attitudinal dimension showed that 64.8%, 82.1% and 64.2%, respectively, believed that communication and co-operation between pharmacists was important for the medication management of patients (A2), that health education for patients and their families was very important (A3) and that communication between cardiovascular and respiratory medicine was very important for the management of patients (A7). In addition, 41.3% agreed that cardiovascular medicine should pay more attention to hypertension combined with asthma (A5) (table 2).
Table 2. Attitude dimension of the participants.
| Very important | Important | Not necessarily | Not important | Not at all important | |
| 1. I consider asthma to be more important compared with other complications of hypertension. | 303 (51.7) | 206 (35.2) | 72 (12.3) | 5 (0.9) | 0 (0.0) |
| 2. Effective communication and collaboration with in-house pharmacists are crucial for the medication management of patients with hypertension and concurrent asthma. | 380 (64.8) | 170 (29.0) | 28 (4.8) | 7 (1.2) | 1 (0.2) |
| 3. Providing health education for patients and their families is extremely important. | 481 (82.1) | 91 (15.5) | 12 (2.0) | 2 (0.3) | 0 (0.0) |
| 4. I believe that patients with low income and those who frequently miss appointments find it more challenging to adhere to medication. | 310 (52.9) | 186 (31.7) | 76 (13.0) | 10 (1.7) | 4 (0.7) |
| 5. The level of attention given by cardiovascular internal medicine to hypertension combined with asthma is not sufficient. | 215 (36.7) | 242 (41.3) | 71 (12.1) | 45 (7.7) | 13 (2.2) |
| 6. It is particularly important to use certain specific antihypertensive and asthma medications sparingly and cautiously, as well as non-pharmacological treatments. | 292 (49.8) | 232 (39.6) | 53 (9.0) | 9 (1.5) | 0 (0.0) |
| 7. Management of patients with hypertension and concurrent asthma requires extensive communication between cardiovascular internal medicine and respiratory internal medicine. | 376 (64.2) | 188 (32.1) | 20 (3.4) | 2 (0.3) | 0 (0.0) |
For all practice items, except P11, the highest proportion often performed them; specifically, 43.3% often provided medication instructions to patients with hypertension (P1), 46.6% often reminded patients to control their weight (P5) and 46.9% often reminded patients to exercise regularly (P8). In addition, 28.2% reported that lectures on hypertension combined with asthma were sometimes conducted in their hospitals (P11) (table 3).
Table 3. Practice dimension of the participants.
| Almost never | Rarely | Sometimes | Often | Always | |
| 1. The frequency with which I provide medication instructions to patients with hypertension. | 31 (5.3) | 55 (9.4) | 109 (18.6) | 254 (43.3) | 137 (23.4) |
| 2. The frequency with which I explain the differences between preventive medication and medication for symptoms to hypertensive patients with asthma. | 43 (7.3) | 101 (17.2) | 156 (26.6) | 194 (33.1) | 92 (15.7) |
| 3. The frequency with which I advise obese or hypertensive pregnant women about the risk of asthma in their offspring. | 81 (13.8) | 108 (18.4) | 146 (24.9) | 162 (27.6) | 89 (15.2) |
| 4. The frequency with which I remind patients about the importance of controlling salt intake in their daily lives. | 24 (4.1) | 24 (4.1) | 83 (14.2) | 266 (45.4) | 189 (32.3) |
| 5. The frequency with which I remind patients about the importance of weight management in their daily lives. | 18 (3.1) | 28 (4.8) | 92 (15.7) | 273 (46.6) | 175 (29.9) |
| 6. The frequency with which I remind patients about the importance of moderating alcohol consumption in their daily lives. | 16 (2.7) | 19 (3.2) | 81 (13.8) | 267 (45.6) | 203 (34.6) |
| 7. The frequency with which I remind patients about the importance of quitting smoking in their daily lives. | 13 (2.2) | 21 (3.6) | 65 (11.1) | 249 (42.5) | 238 (40.6) |
| 8. The frequency with which I remind patients about the importance of regular exercise in their daily lives. | 15 (2.6) | 23 (3.9) | 90 (15.4) | 275 (46.9) | 183 (31.2) |
| 9. The frequency with which I remind patients about the importance of avoiding drug abuse in their daily lives. | 18 (3.1) | 16 (2.7) | 87 (14.8) | 265 (45.2) | 200 (34.1) |
| 10. The frequency with which I pay attention to the family history of asthma in patients with isolated hypertension. | 46 (7.8) | 119 (20.3) | 147 (25.1) | 164 (28.0) | 110 (18.8) |
| 11. The frequency with which lectures on the disease of hypertension combined with asthma are conducted at my hospital. | 87 (14.8) | 128 (21.8) | 165 (28.2) | 127 (21.7) | 79 (13.5) |
Correlation analyses indicated significant positive correlations between knowledge and attitude (r=0.395, p<0.001), as well as practice (r=0.283, p<0.001). Also, there was a correlation between attitude and practice (r=0.208, p<0.001) (online supplemental table S2).
The multivariate logistic regression showed that having an education with Bachelor’s degree or higher (OR=0.614, 95% CI (0.421,0.896), p=0.011) and having a knowledge score greater than or equal to 8 (OR=2.130, 95% CI (1.527,2.973), p<0.001) were independently associated with practice (online supplemental table S3).
The SEM model (figure 1) was adjusted to achieve an ideal fit (online supplemental table S4); the results showed that direct effects existed between knowledge and attitude (β=0.578,p=0.010) and between knowledge and practice (β=0.221, p=0.010). However, the direct effects between attitude and practice (β=0.162, p=0.052) and the indirect effects between knowledge and practice (β=0.094, p=0.052) were not significant (table 4).
Figure 1. The structural equation model before and after model adjustment. (A) Before model adjustment； (B) after model adjustment. Rectangle shows observed variables, ellipses indicate potential variables and circles represent residual terms.
Table 4. Bootstrap analysis of a mediating effect significance test for the final mode.
| Standardised direct effects | P value | 95% CI | Standardised indirect effects | P value | 95% CI | |||
| LLCI | ULCI | LLCI | ULCI | |||||
| K-A | 0.578 | 0.010 | 0.468 | 0.675 | – | – | – | – |
| K-P | 0.221 | 0.010 | 0.081 | 0.367 | – | – | – | – |
| A-P | 0.162 | 0.052 | −0.002 | 0.298 | – | – | – | – |
| K-P | – | – | – | – | 0.094 | 0.052 | −0.001 | 0.177 |
LLCILower Limit Confidence IntervalULCIUpper Limit Confidence Interval
Discussion
Healthcare professionals had inadequate knowledge, positive attitudes and inactive practices towards the management of patients with both hypertension and bronchial asthma. It is imperative to implement targeted educational interventions and training programmes aimed at improving the knowledge and practices of healthcare professionals in the management of patients with comorbid hypertension and bronchial asthma, ultimately enhancing the quality of care provided to these patients.
Notably, workplace type emerged as a significant factor influencing clinical practices. Township health centre and community hospital employees exhibited notably higher levels of engagement in appropriate clinical practices compared with their counterparts in different workplace settings. This finding suggests that healthcare facilities with a primary care focus may be more effective in promoting guideline-concordant practices for patients with both hypertension and bronchial asthma. Such a result aligns with the role of primary care settings in the early detection and management of chronic diseases, including hypertension and asthma.14 15 Additionally, department type was found to impact knowledge levels, with healthcare professionals in cardiovascular internal medicine displaying lower knowledge scores. This outcome raises questions about the adequacy of training and continuing medical education in this particular department regarding the management of comorbid hypertension and bronchial asthma. To address this discrepancy, department-specific educational interventions could be designed to bridge the knowledge gap among healthcare professionals.16 17 Furthermore, professional title appeared to influence attitudes, with individuals holding no professional title demonstrating lower attitude scores. This result suggests that the professional status or role within the healthcare hierarchy may influence how healthcare professionals approach the management of comorbid conditions.
The strong positive correlations identified between knowledge and both attitude and practice indicate that enhancing healthcare professionals’ knowledge could serve as a cornerstone for fostering positive attitudes and improving clinical practices. This finding underscores the value of educational initiatives and continuous professional development programmes to bolster their knowledge base, ultimately translating into more effective patient care.18 19 However, despite these correlations, the SEM results revealed some intriguing insights. While direct effects existed between knowledge and attitude, as well as between knowledge and practice, the absence of a significant direct effect between attitude and practice suggests that factors beyond knowledge and attitude may contribute to healthcare professionals’ clinical behaviours in this context. There are several factors that may explain why attitude did not fully translate into practice: deficiencies in clinical guidelines, particularly the lack of specific recommendations for managing comorbid hypertension and asthma, may lead to insufficient practice guidance for healthcare professionals. Similarly, the non-significant indirect effects between knowledge and practice indicate that other unmeasured variables may influence the translation of knowledge into practice. This finding underscores the complexity of behaviour change in healthcare and emphasises the need for multifaceted interventions that go beyond merely imparting knowledge.20 21
In evaluating the knowledge dimension of healthcare professionals regarding the management of patients with concurrent hypertension and bronchial asthma, certain key findings warrant discussion. The most prominent finding was that a significant proportion of participants held misconceptions regarding the relationship between asthma severity and blood pressure levels, as well as the link between decreased lung function in asthma patients and cardiovascular-related mortality. These misconceptions may arise from the complex nature of this comorbidity or from insufficient exposure to current evidence-based research. Therefore, interventions should focus on disseminating accurate and up-to-date information regarding the interplay between these conditions, with a specific emphasis on addressing these misconceptions. Additionally, the item concerning the characteristics of asthma combined with hypertension revealed a substantial knowledge deficit among participants. A majority lacked awareness of critical features, such as airway hyperresponsiveness, structural remodelling and increased vascular tension, which are fundamental for understanding the pathophysiological mechanisms of this comorbidity. This knowledge gap may hinder healthcare professionals in making informed clinical decisions for patients with both conditions. Hence, it is imperative to provide healthcare professionals with ongoing training and knowledge updates regarding the intricate interplay between hypertension and bronchial asthma.22 23 Regular seminars, online training courses and access to the latest research literature should be made available to ensure that healthcare practitioners remain abreast of current advancements. This will enable them to make informed decisions in the management of patients with these comorbid conditions.
Turning to the attitude dimension, healthcare professionals displayed positive attitudes toward the management of patients with concurrent hypertension and bronchial asthma. Notably, a majority emphasised the importance of health education for patients and their families, aligning with the principles of patient-centred care, which views patient education as a cornerstone of effective chronic disease management.24 25 Furthermore, the majority expressed the importance of effective communication and collaboration with in-house pharmacists in medication management and recognised the significance of collaboration between cardiovascular internal medicine and respiratory internal medicine. These findings suggest a willingness to engage in interdisciplinary teamwork, which is crucial in managing complex comorbid conditions. However, some participants indicated that they consider asthma to be more important than other complications of hypertension, which may imply a potential bias. Addressing this bias and ensuring equitable prioritisation of conditions is essential for comprehensive patient care. To foster an equitable approach to patient care, healthcare professionals must be educated to avoid favouring one disease over another.26 27 Patients with comorbid conditions, such as hypertension and bronchial asthma, deserve equal consideration and attention. Promoting an objective attitude among healthcare providers is paramount to achieving this goal. Furthermore, encouraging interdisciplinary collaboration is crucial. Healthcare professionals from various disciplines should actively seek opportunities to work together in managing patients with comorbid conditions. Regular team meetings and case discussions facilitate knowledge exchange and can result in more comprehensive and effective patient care. Collaboration between cardiovascular internal medicine and respiratory internal medicine, for instance, can lead to a holistic approach to patient management, addressing both hypertension and bronchial asthma concurrently.28 29
In the practice dimension, the frequency with which healthcare professionals provided medication instructions to patients with hypertension was generally high. This suggests a commitment to patient education, which is essential for medication adherence and improved health outcomes. Nevertheless, there is room for improvement in explaining the differences between preventive medication and symptom-based medication to hypertensive patients with asthma. Improved communication in this regard could enhance patients’ understanding of their treatment plans. Additionally, the low frequency of conducting lectures on hypertension combined with asthma at participants' hospitals highlights an educational gap that needs attention. Enhancing patient education is a critical aspect of improving practice. Healthcare professionals should prioritise providing clear and comprehensive information to patients and their families, particularly regarding treatment plans and medication adherence. Effective communication can empower patients to actively participate in their own care, leading to better treatment outcomes.30 31 Moreover, addressing the gap in conducting educational sessions on comorbid hypertension and bronchial asthma at healthcare institutions is essential. Regular lectures and training sessions can help healthcare professionals acquire the knowledge and skills necessary to manage these complex conditions effectively.
This study has several limitations. First, it relied on self-reported data, which can introduce recall bias or social desirability bias, potentially impacting the accuracy of responses provided by participants. Second, the cross-sectional design used in this study does not allow for the establishment of causality, and longitudinal research is necessary to further explore the intricate relationships between knowledge, attitudes and clinical practices among healthcare professionals who manage patients with hypertension and bronchial asthma. Third, the study’s findings may have limited generalizability due to potential differences in healthcare systems, cultural contexts and practices across different regions.
Additionally, it should be noted that this study was conducted across multiple healthcare facilities, including some in rural or community-based settings. Given that patients with comorbid hypertension and bronchial asthma often suffer from chronic conditions, their ongoing management primarily occurs in grassroots healthcare institutions, such as township clinics and community health centres. Consequently, the knowledge and awareness of healthcare personnel at the grassroots level can significantly influence the subsequent guidance and care provided to these patients.
Conclusions
In conclusion, healthcare professionals demonstrated inadequate knowledge, positive attitudes and inactive practices towards the management of patients with both hypertension and bronchial asthma. To enhance the quality of care for patients with these concurrent conditions, targeted educational interventions and continuous professional development programmes are essential. Specifically, there is a need to improve existing clinical guidelines, develop specialised training modules focused on the integrated management of comorbid hypertension and bronchial asthma, and encourage regular updates and refresher courses for healthcare professionals. Additionally, ongoing monitoring and evaluation of training effectiveness should be established to ensure that improvements in knowledge translate into better attitudes and more proactive clinical practices.
supplementary material
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2024-088743).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Consent obtained directly from patient(s).
Ethics approval: This work has been carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association. The study was approved by the Ethics Committee of Binzhou Medical University Hospital. The study included practicing physicians and nurses specialising in clinical internal medicine with over 2 years of experience, who provided online informed consent. All data were anonymized to ensure confidentiality and used solely for research purposes. Participants had the right to withdraw from the study at any time.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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