Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh.
Healthcare Improvement Scotland, Improvement Hub, Evidence and Evaluation for improvement Team, Edinburgh.
Br J Gen Pract. 2020 Apr 30;70(694):e303-e311. doi: 10.3399/bjgp20X708869. Print 2020 May.
In the context of a variable condition such as asthma, patient recognition of deteriorating control and knowing what prompt action to take is crucial. Yet, implementation of recommended self-management strategies remains poor.
To explore how patients with asthma and parents/carers of children with asthma develop and establish recommended self-management strategies for living with asthma, and how clinicians can best support the process.
A qualitative study in UK primary care.
Patients with asthma and parents/carers of children with asthma from 10 general practices were purposively sampled (using age, sex, and duration of asthma) to participate in focus groups or interviews between May 2016 and August 2016. Participants' experiences of health care, management of asthma, and views on supported self-management were explored. Interviews and focus group sessions were audio-recorded and transcribed verbatim. Iterative thematic analysis was conducted, guided by the research questions and drawing on habit theory in discussion with a multidisciplinary research team.
A total of 49 participants (45 patients; 4 parents/carers) took part in 32 interviews and five focus groups. Of these, 11 reported using an action plan. Patients learnt how to self-manage over time, building knowledge from personal experience and other sources, such as the internet. Some regular actions, for example, taking medication, became habitual. Dealing with new or unexpected scenarios required reflective abilities, which may be supported by a tailored action plan.
Patients reported learning intuitively how to self-manage. Some regular actions became habitual; dealing with the unexpected required more reflective cognitive skills. In order to support implementation of optimal asthma self- management, clinicians should consider both these aspects of self-management and support, and educate patients proactively.
在哮喘等多变的情况下，患者能否识别病情恶化以及知晓应采取何种行动至关重要。然而，推荐的自我管理策略的实施情况仍不容乐观。
探究哮喘患者和儿童哮喘患者的父母/照顾者如何制定和建立推荐的哮喘管理策略，以及临床医生如何最好地支持这一过程。
英国初级保健机构中的定性研究。
从 10 家全科诊所中选择有哮喘的患者和有哮喘的儿童的父母/照顾者作为研究对象（按年龄、性别和哮喘持续时间进行选择），以参与 2016 年 5 月至 2016 年 8 月期间的焦点小组或访谈。参与者探讨了他们的医疗保健经历、哮喘管理以及对支持性自我管理的看法。采访和焦点小组会议都进行了录音，并逐字记录。在研究问题的指导下，进行了迭代主题分析，并与多学科研究团队一起运用习惯理论进行了讨论。
共有 49 名参与者（45 名患者；4 名父母/照顾者）参与了 32 次访谈和 5 次焦点小组。其中 11 名参与者使用了行动计划。患者随着时间的推移逐渐学会自我管理，从个人经验和互联网等其他来源获取知识。一些常规的行动，例如服药，逐渐成为习惯。处理新的或意外的情况需要反思能力，这可能需要一个量身定制的行动计划来支持。
患者报告说他们凭直觉学会了自我管理。一些常规的行动变得习惯化；处理意外情况需要更多的反思认知技能。为了支持最佳哮喘自我管理的实施，临床医生应该考虑自我管理和支持的这两个方面，并积极教育患者。
