Walters Gareth I, Soundy Andy, Robertson Alastair S, Burge P Sherwood, Ayres Jon G
Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Respir Med. 2015 Mar;109(3):379-88. doi: 10.1016/j.rmed.2015.01.003. Epub 2015 Jan 26.
Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms. Reducing this delay could improve workers' quality of life, and reduce the societal cost of occupational asthma. This study aimed to explore reasons behind such delays.
A purposive sample of 20 individuals diagnosed with, or under investigation for, occupational asthma (median age = 52; 70% male; 80% white British) undertook a single semi-structured interview. Interviews were transcribed verbatim and thematic analysis was undertaken in order to explore health beliefs and identify barriers to diagnosis.
Four themes were identified: (1) workers' understanding of symptoms, (2) working relationships, (3) workers' course of action and (4) workers' negotiation with healthcare professionals. Understanding of symptoms varied between individuals, from a lack of insight into the onset, pattern and nature of symptoms, through to misunderstanding of what they represented, or ignorance of the existence of asthma as a disease entity. Workers described reluctance to discuss health issues with managers and peers, through fear of job loss and a perceived lack of ability to find a solution. The evolution of workers' understanding depended upon how actively they looked to define symptoms or seek a solution. Proactive workers were motivated to seek authoritative help and negotiate inadequate healthcare encounters with GPs.
Understanding workers' health beliefs will enable policy makers and clinicians to develop better workplace interventions that may aid diagnosis and reduce delay in identifying occupational asthma.
在英国、欧洲和加拿大，有报告称从症状出现到职业性哮喘诊断存在长时间延误，而且工人往往不愿就其症状寻求医疗帮助或工作场所解决方案。减少这种延误可以改善工人的生活质量，并降低职业性哮喘的社会成本。本研究旨在探讨此类延误背后的原因。
对20名被诊断为职业性哮喘或正在接受职业性哮喘调查的个体（中位年龄 = 52岁；70%为男性；80%为英国白人）进行了有目的抽样，开展了一次半结构化访谈。访谈内容逐字转录，并进行了主题分析，以探究健康观念并确定诊断的障碍。
确定了四个主题：（1）工人对症状的理解，（2）工作关系，（3）工人的行动过程，（4）工人与医疗保健专业人员的协商。个体对症状的理解各不相同，从对症状的发作、模式和性质缺乏洞察力，到对症状所代表的含义存在误解，或对哮喘作为一种疾病实体的存在一无所知。工人们表示，由于担心失业以及认为无法找到解决方案，所以不愿与经理和同事讨论健康问题。工人理解的演变取决于他们积极定义症状或寻求解决方案的程度。积极主动的工人有动力寻求权威帮助，并就与全科医生的医疗接触不足进行协商。
了解工人的健康观念将使政策制定者和临床医生能够制定更好的工作场所干预措施，这可能有助于诊断并减少职业性哮喘识别过程中的延误。
