Table 4.
Health beliefs about asthma and its management
| Sub-theme | Summary findingsa |
|---|---|
| Health beliefs of patient or carer, as a barrier to SM. | • Patients’ health beliefs and illness representations30 can be a barrier to care and SM, directly influencing how they manage asthma24,28,32 (R). |
| • Patients often omit health beliefs that are not consistent with western medicine from discussion with their GP24 (P). | |
| • Patients who have confidence in taking medicines also avoid ED re-attendance44 (R). | |
| • Some ethnic minority patients and carers (Puerto-Rican patients, and Mexican mothers) treat asthma based on beliefs that they need to address imbalances between hot and cold28,30 (Ch/Ca). They also focus on self- management techniques that alter the environment or emotions28 (Ch/Ca). | |
| • Some children and carers attribute their asthma to having too much exercise and can list some environmental triggers26,66 (Ch/Ca). Others (including African American women, children and carers) reported physical activity to be beneficial33–35 (P/Ca/Ch) | |
| • Many young people assess asthma in terms of how ‘normal’ they appear in front of their peers36,51 (Ch). | |
| • Many carers (including Taiwanese mothers) use the occurrence of asthma attacks, symptoms and behavioural change to assess the asthma51,66 (Ca). | |
| • The extent to which asthma symptoms impact on the family is used to assess severity of asthma28 (Ca). | |
| Validity of the diagnosis and acceptance | • Some patients do not accept their diagnosis and consequently have poor self-management. They may deny their asthma or minimise its severity23,53,62, forget medications29 and not follow action plans55 (P). |
| • Some carers from ethnic minorities believe the disease is only present when their child is symptomatic30 (Ca). | |
| • Text message mobile technology might help some patients accept and come to term with their diagnosis47 (P, HCP). | |
| • Some carers find it difficult to accept the diagnosis, due to negative stigma74 and no clear diagnostic test52,75 (Ca). | |
| • Some carers avoid admitting to their child’s diagnosis and describe the difficulties in diagnosing asthma30,65 (Ca). | |
| Views of asthma with regards to self-management (positive and negative aspects) | POSITIVE: |
| • Most patients are aware of the episodic nature of asthma30,45,67,68 and the main aims and components of self-management59 (P). | |
| • Due to the potential negative impact on self-image, some patients are motivated to fight back and control their asthma49 (P). Disliking feeling out of control with symptoms is a motivator for gaining and maintaining control22,67 (P). | |
| • Most carers want their children to be treated normally and not let the asthma limit their children’s lives. Carers do not want asthma to be used as an excuse to not do particular things, i.e., chores64 (Ca). | |
| • Some older patients (>50 yrs), with a recent diagnosis seek to understand the cause of their asthma and access information to self-manage it57 (P). | |
| NEGATIVE: | |
| • Some patients view asthma as a burden67 (P). | |
| • A sense of despondency resulted from asthma attacks despite positive personal action59 (P). | |
| • Some patients, including those with intellectual disabilities are embarrassed to use inhalers in public due to concerns about what others will think22,30,33,45,54 (P/Ch). | |
| • Some patients tend not to disclose their asthma in public and prefer to describe their symptoms using terms such as ‘breathing difficulties’45 (P). | |
| • Some older patients (>50 years of age) with a long-term diagnosis, base their self-management strategies on past experience, e.g., concealing symptoms due to the negative stigma of asthma57 (P). | |
| • Some carers are concerned that asthma will affect learning and relationships64 (Ca). | |
| Motivators of self-management | • Patients tend to be motivated to manage their asthma: i) when symptoms cause discomfort; ii) if they believe asthma may have serious consequences; and iii) when asthma affects a valued activity30,49,63 (P/HCP). Some were not motivated to act until it posed a life threatening state59 (P). |
| • Some patients with severe asthma are motivated to manage their asthma by balancing good aspects of treatment (e.g., medicine helps them to engage in everyday activities), with bad aspects (e.g., side effects of medicines)61 (P). | |
| • Some teenagers, including Urban African Americans, do not see the importance of visiting the doctor for review,11,71 particularly when feeling well33,71 and can be unwilling to take medications71 (Ch). | |
| • Carers tend to focus on the most bothersome symptoms, so adapt their written action plan (Ca). Treating only symptoms that bother the carer, instead of self-adjustment of medication in line with action plans, goes against GP advice70 (R). | |
| • If asthma is normalised by the patient and its effects not noticed there is no motivation to self-manage36,49 (P/Ch). | |
| Self-efficacy for self-management of asthma | • In adolescents poor asthma control is associated with limited perceived ability to control asthma71 (R). |
| • High self-efficacy is associated with patient beliefs that exercise, trigger avoidance, using an inhaler, and taking preventer medication makes a difference27 (Ch/R), and that they have the skills knowledge and confidence to control things on a daily basis59 (P). | |
| • Low self-efficacy for self-management was influenced by factors out of the individual’s control (e.g., others’ smoking or the weather)59 (P). | |
| Child takes responsibility for care in different ways to those expected by the parent | • Carers and children hold differing views of how to be responsible for managing their asthma53 (R). |
| • Some children take responsibility for their asthma by making the effort to minimise the limitations of the illness and using non-medical interventions, such as sitting out an activity42,53 (R/Ch). | |
| • Some children report awareness of triggers and tell someone when they feel unwell26 (Ch). | |
| Transfer of responsibility in managing asthma | • Transfer of responsibility from carer to child in managing asthma is gradual,34,53 and negotiated29,34 (Ca, R). |
| • Text message interventions that help the patient monitor symptoms are useful to aid transition of responsibility47 (R). | |
| • Some carers secretly monitor children’s asthma symptoms and whether they are taking their medications52,53 (R, Ca). | |
| • Many Taiwanese carers are fearful when children start school, as they will be unable to manage their child’s asthma during school time.64 Others want the child to take responsibility for their self-care and medication,64,66 including when at school,31 and teach them to avoid asthma episodes in ways they perceive as effective, e.g., by dressing warmly and changing clothes when wet64 (Ca). | |
| Who is responsible for managing asthma | • Many adults and carers believe that asthma self-management is their responsibility based on their own judgement and awareness of triggers, without an alliance with their GP39,59,72 (P/Ca). |
| • Parents have concerns over balancing monitoring medication use and encouraging independence (feeling children should take responsibility in case they are not around during an attack)28,52,53,66 (Ca). | |
| • The primary carer usually takes responsibility for young children but parents expect older children to do so29 (Ca/R). | |
| • When children do not successfully manage their asthma, carers take this responsibility back42,75 (Ca/Ch). | |
| • Some nurses suggest involving children in consultations to show their carers they are becoming independent52 (HCP). | |
| • Children and Teenagers can have worse adherence and morbidity due to less parental supervision28,72 (Ca/R). | |
| • School staff are often unclear how to manage asthma, with some being over cautious (e.g., unnecessarily excluding African American teenagers from activities), or under cautious (e.g., not believing African American teenagers reporting symptoms)33,34,37 (Ch/Ca/S). | |
| Goals of patient and treatment expectations | • Patients (including Urban African American adolescents and young adults) and carers main goals are to treat symptoms (rather than prevent symptoms or attacks)33,43,62,68,72,74 (P/Ca/Ch). |
| • Some patients aim to live symptom-free,67 to be cured, or to have control over their asthma49 (P). Others aim to learn to live with asthma30 (Ca). | |
| • Few patients have a goal, have worked with the HCP to set a goal, or have planned ways to achieve a goal22 (P). Some HCPs suggest this is due to a lack of time necessary to carry out with patients39 (HCP). | |
| • Some patients expect treatment to improve their breathing and prevent further attacks45 (P). |
a Type of person who expressed their viewpoint (P patient viewpoint, HCP health care professional viewpoint, Ca carer viewpoint, Ch child/adolescent’s viewpoint, R researcher’s viewpoint, S school personnel’s viewpoint)