|Year : 2019 | Volume
| Issue : 3 | Page : 93-97
Assessment of knowledge regarding self-management of bronchial asthma among patients attending the outpatient department of a North Zone tertiary care center
Ankita Sukhpal Kaur1, Neena Vir Singh1, Ashutosh Aggarwal2
1 National Institute of Nursing Education, PGIMER, Chandigarh, India
2 Department of Pulmonary Medicine, PGIMER, Chandigarh, India
|Date of Web Publication||27-Sep-2019|
Dr. Ankita Sukhpal Kaur
National Institute of Nursing Education, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Background: Bronchial asthma is a well-known chronic illness with a significant burden. The chronic nature of the disease demands time to time management. Knowledge about the disease condition is essential to understand the dynamic nature of the symptoms. Therefore, it is important to assess the knowledge of the patients related to disease, so that further teaching can be planned to educate them about their disease condition and self-management measures.
Objective: The objective of this study was to assess the knowledge of patients regarding self-management of bronchial asthma.
Materials and Methods: One hundred and thirty-five participants with varying asthma severity were enrolled in the study group. Each participant was interviewed using a prevalidated questionnaire consisting of 19 items. The items were divided into three subcategory questions related to disease condition, triggering factors and symptoms, and correct inhalation device use and acute management. The scores were categorized into three categories, namely poor (0–6), moderate (7–12), and good (13–19) knowledge score.
Results: Poor knowledge has been seen in 10.37%. The mean knowledge score of the participants was 10.24 ± 3.11 and ranged from 4 to 17. There was a negative linear correlation between duration of diagnosis and knowledge score (r = −0.16, P > 0.05). A slight positive linear correlation was seen in age and knowledge score (r = 0.2, P < 0.05), and a negative linear correlation was spotted in educational status and knowledge score (r = −0.24, P < 0.05).
Conclusion: Written educational material should be routinely provided to patients to enhance their understanding and knowledge about disease condition and its proper management.
Keywords: Bronchial asthma, knowledge, self-management
|How to cite this article:|
Kaur AS, Singh NV, Aggarwal A. Assessment of knowledge regarding self-management of bronchial asthma among patients attending the outpatient department of a North Zone tertiary care center. Int J Non-Commun Dis 2019;4:93-7
|How to cite this URL:|
Kaur AS, Singh NV, Aggarwal A. Assessment of knowledge regarding self-management of bronchial asthma among patients attending the outpatient department of a North Zone tertiary care center. Int J Non-Commun Dis [serial online] 2019 [cited 2019 Dec 10];4:93-7. Available from: http://www.ijncd.org/text.asp?2019/4/3/93/268138
| Introduction|| |
Bronchial asthma is a well-known worldwide illness with a noticeable burden at all health-care settings. It has been observed that the patients have less knowledge about self-management measures and are also noncompliant to treatment. Active participation of the patient is required for targeting self-management. Being a chronic illness, asthma may have a substantial impact on several facets of patient's life. It affects financial, medical, social, and rest of the other dimensions at variable levels. The dynamic nature of the disease requires long-term management. The magnitude of the condition is high on both primary and secondary health-care settings., The overall impact of asthma on health can be best approximated by asthma control. It is said to be well controlled when the symptoms are less, and there is no use of quick-reliever medication. Asthma control and asthma-related quality of life both are important factors at different levels. The variability and long-term nature of the disease condition make patients active participants to manage their condition. Active participation by the patient helps to achieve adequate disease control. Thus, it is important that patients are prepared for self-management. Self-management can be achieved properly only if the knowledge about the disease and the symptoms is good enough to identify the severity of the symptom, as well as triggers. Avoidance of allergens results in reduced asthma symptoms. Primary prevention of the disease can be achieved by avoiding indoor allergens. Several studies report that knowledge about the symptoms and prompt measures in response to the symptoms can lead to better control.,,, Considering the importance of having knowledge about asthma for self-management this disease, the current study was planned with an objective to assess the knowledge regarding self-management of bronchial asthma.
| Materials and Methods|| |
The study was conducted at the chest clinic at a tertiary medical center, where 30–40 new cases of bronchial asthma are seen on each outpatient day. A cross-sectional study design was selected, and 135 patients suffering from bronchial asthma were enrolled using a purposive sampling technique during the period July–November 2018. Ethical approval was obtained from the institute ethics committee, and written informed consent was obtained from all participants prior to enrollment.
Demographic variables, clinical profile, and knowledge of participants regarding the disease and management were assessed. An objective questionnaire for the assessment of knowledge about bronchial asthma was constructed and validated. Nineteen items focusing on disease condition, etiology, signs and symptoms, and self-management were included in the questionnaire. Each correct response was scored with 1 mark. All items carried equal weightage, and the maximum attainable score was 19. The knowledge questionnaire was divided into three subsets based on questions related to disease condition and management. Subset 1 had questions related to disease condition (question number 1–5), subset 2 on triggering factors and symptoms (question number 6–9), and subset 3 on correct inhalation device use and acute management (question number 10–19). The overall scores were categorized into three categories, namely poor knowledge (0–6), moderate knowledge (7–12), and good knowledge (13–19).
Data were analyzed using the software Statistical Package for the Social Sciences (IBM SPSS version 22, IBM, Armonk, New York, Westchester). Descriptive data were reported as numbers and proportions. Spearman's rank sum correlation between knowledge score and key disease variables was also determined.
| Results|| |
One hundred and thirty-five participants were enrolled in the study group using the purposive sampling technique. The demographic profile, personal profile, and clinical profile of the participants have been described in [Table 1] and [Table 2], respectively. Mean age of the participants was 36.47 ± 13.74. The mean per capita income was Rs. 6456. More than two-third of participants (68.3%) were residents of rural areas. More than two-third (68.8%) of the participants were not working and 28.2% attained education till middle class [Table 1]. The sedentary lifestyle pattern was noted in 62 (45.9%) participants. Majority of the participants (84.4%) had pucca house. About 11.85% of the participants were still using traditional chulhas for cooking [Table 2]. The most common triggering factor was seasonal variations (74, 54.8%). Other common triggering factors included smell (6, 4.4%), exercise (9, 6.6%), and pollution (23, 17.0%), and few patients had more than one identified trigger. Majority (83.7%) of the participants had the disease for more than a year. Metered-dose inhaler (MDI) along with spacer was used by 107 (79.3%) patients [Table 3].
|Table 3: Item-wise knowledge scores of participants regarding asthma disease|
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The mean knowledge score was 10.24 ± 3.11, with a median of 10 and a range of 4–17. The mean score of subset 1 was 3.42 ± 0.92 and subset 2 was 2.53 ± 0.99. The mean knowledge score of subset 3 was 6.48 ± 1.79. Although it has been seen that the maximum attainable score in subset 3 including questions based on the correct use of inhalation devices and acute management was 12, the average score attained by participants was 6.48. It indicates that participants had inadequate knowledge related to management measures.
More than 10% (10.37%) of the participants had poor knowledge. Nearly, two-third (64.44%) of the participants had moderate knowledge and 25.19% had good knowledge. The knowledge scores per items are given in [Table 3].
Half (52.6%) of the participants knew that asthma is a problem of the lungs. Only 21.5% knew that it causes narrowing in the lung airways. More than two-third (67.4%) of the participants knew that allergy is the main causative factor of bronchial asthma, and 51.1% knew that family history of asthma can cause bronchial asthma in the family. Smoking and dust particles and allergy as the triggers of acute asthma attacks were known to more than half (57.5%) of the participants.
Symptomatology analysis revealed that majority (82.2%) of the participants had breathing difficulty as a common symptom. Cough was present in half (53.3%) of the participants.
Nearly, three-quarter (71.9%) of the participants knew that they should take inhaler at the time of acute attacks; however, two-third (65.2%) of the participants knew that while taking inhaler, they should breathe slowly through the mouth, and 40.8% had idea that they should hold their breath for 5–10 s after taking inhaler. Nearly, two-third (66.7%) of the participants were aware that the mouth should be rinsed after taking inhaler. However, only 39.3% knew that rinsing the mouth prevents secondary infection.
Peak flow meter device is used for early identification of symptoms was known to 9.6% of participants in the current study. Majority (83%) of the participants knew that fast-relief medicine should be taken at the time emergency and should go to the hospital.
There was a negative linear correlation between duration of diagnosis and knowledge score (r −0.16, P > 0.05). The knowledge score did not increase with an increase in duration of diagnosis. This suggests that although the duration of diagnosis was ≥1 year for many participants, they had less knowledge about their disease condition and self-management measures. Although there was a slight positive linear correlation between age and mean knowledge score (r 0.2, P < 0.05), it indicated that with the increase in age, the knowledge score also increased. There was a negative linear correlation between educational status and knowledge score (r = −0.24, P < 0.05). The findings indicate that higher educational level does not affect knowledge about asthma. Although there was a weak positive correlation between knowledge score and socioeconomic status (r 0.18, P < 0.05), this indicates that knowledge score was increased with high socioeconomic status. Correlation details are given in [Table 4].
|Table 4: Correlation of knowledge score with age, duration of diagnosis, educational status, and socioeconomic status|
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| Discussion|| |
Bronchial asthma is a chronic illness with life-long management goals. The management can be effective if the participants are provided information about the disease and possess good knowledge about the condition. The mean knowledge score of the participants was 10.24 ± 3.11, with a median of 10. More than 10% (10.37%) of the participants had poor knowledge and 64.44% had moderate knowledge.
Smoking has been noted as a risk factor for asthma in few previous studies., In the current study, smoking as a risk factor to provoke asthma symptom was addressed by more than half (57%) of the participants. These findings were similar to the findings reported by Aqeel et al. where 69.7% of the participants stated that smoking can worsen asthma symptoms. Family history of bronchial asthma increases the probability of asthma in children., In the present study, nearly half (51.1%) of the participants knew that bronchial asthma is a hereditary disease. Almost identical figures have been reported in few previous studies.,,
The data in the current study revealed that more than half (52.6%) of the participants were aware that asthma is a disease of lungs, whereas only less than a quarter (21.5%) knew that it is an inflammatory disorder. A previous study by Kaur et al. has, however, reported higher figures as compared to this study (81% of the participants knew that asthma is an airway disease and 35% knew that it is an inflammatory disorder). In another study by Demiralay, 22.2% of the participants knew that asthma is an inflammatory disorder, a figure that is largely similar to the present study.
Although bronchial asthma is a noncommunicable disease, the myth that it may be transmitted from one person to other still remains highly prevalent. In the present study, 77.8% of the participants reported bronchial asthma as a communicable disease, which was nearly 2.3-fold higher than reported in a previous study.
More than half (54.8%) of the participants reported seasonal variation as a trigger to bronchial asthma and 79.3% were using MDI device with spacer as treatment. Rinsing mouth is an important component after inhaler use. It helps to remove residual drug from the oral cavity and throat, thereby reducing the chances of secondary infection and other local complications. In the current study, two-third (66.7%) of the participants knew about the importance of rinsing mouth after inhaler use. This was much better than the study done by Kaur et al. where nearly half (48%) of the participants had knowledge about it. In the current study, only 16.3% of the participants were aware that bronchodilators are used for the treatment of bronchial asthma; however, the number was more than half (57%) in the study conducted by Kaur et al. For the management of acute asthma attack, majority (83%) of the participants knew that rapidly acting inhalers should be taken at the time of symptomatic worsening. This was similar to the findings from a previous study by Kaur et al. where majority (88%) had idea for the same.
Airway peak flow monitoring is an inexpensive and easy way for earlier recognition of worsening disease control. In the present study, only 9.6% of the patients knew that peak flow meter is used for the assessment of bronchial asthma control. Similar findings have been documented by Kotwani et al. who reported that only 10% were aware about the peak flow meter use.
| Conclusion|| |
We conclude that knowledge and awareness related to bronchial asthma management measures remain inadequate in our patients, despite long-standing disease and ongoing treatment. Overall knowledge about disease condition and self-management was also insufficient. We suggest that written educational material should be routinely provided to patients to enhance their understanding and knowledge about disease condition and its proper management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Braido F. Failure in asthma control: Reasons and consequences. Scientifica (Cairo) 2013;2013:549252.
Braido F, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, et al.
Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: A GA(2)LEN taskforce position paper. Allergy 2010;65:959-68.
Gibson PG, Coughlan J, Wilson AJ, Abramson M, Bauman A, Hensley MJ, et al
. Self-management education and regular practitioner review for adults with asthma. In: Cochrane Collaboration. Cochrane Library. Oxford: Update Software; 2000.
McCormick SP, Nezu CM, Nezu AM, Sherman M, Davey A, Collins BN. Coping and social problem solving correlates of asthma control and quality of life. Chron Respir Dis 2014;11:15-21.
Behera D, Kaur S, Gupta D, Verma SK. Avoidance of allergens by the patients with bronchial asthma. J Assoc Physicians India 2008;56:325-8.
Kaur S, Behera D, Gupta D, Verma SK. Demographic and environmental factors in patients of bronchial asthma. Indian J Allergy Asthma Immunol 2008;22:85-9.
Charlton I, Charlton G, Broomfield J, Mullee MA. Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice. Br J Gen Pract 1991;41:227-31.
Guidelines for the management of asthma: A summary. British thoracic society and others. BMJ 1993;306:776-82.
Behera D, Kaur S, Gupta D, Verma SK. Evaluation of self-care manual in bronchial asthma. Indian J Chest Dis Allied Sci 2006;48:43-8.
Kaur S, Behera D, Gupta D, Verma SK. Evaluation of a “supportive educative intervention” on self-care in patients with bronchial asthma. Nur Midwifery Res J 2009;5:124-32.
Plaschke PP, Janson C, Norrman E, Björnsson E, Ellbjär S, Järvholm B. Onset and remission of allergic rhinitis and asthma and the relationship with atopic sensitization and smoking. Am J Respir Crit Care Med 2000;162:920-4.
Rasmussen F, Siersted HC, Lambrechtsen J, Hansen HS, Hansen NC. Impact of airway lability, atopy, and tobacco smoking on the development of asthma-like symptoms in asymptomatic teenagers. Chest 2000;117:1330-5.
Aqeel T, Akbar N, Dhingra S, Noman-ul-Haq. Assessment of knowledge and awareness regarding asthma among school teachers in urban area of Quetta, Pakistan. J Pharm Pract Community Med 2015;1:18-23.
Burke W, Fesinmeyer M, Reed K, Hampson L, Carlsten C. Family history as a predictor of asthma risk. Am J Prev Med 2003;24:160-9.
Evans M, Palta M, Sadek M, Weinstein MR, Peters ME. Associations between family history of asthma, bronchopulmonary dysplasia, and childhood asthma in very low birth weight children. Am J Epidemiol 1998;148:460-6.
Demiralay R. The effects of asthma education on knowledge, behaviour and morbidity in asthmatic patients. Turk J Med Sci 2004;34:319-26.
Kotwani A, Chhabra SK, Tayal V, Vijayan VK. Quality of asthma management in an urban community in Delhi, India. Indian J Med Res 2012;135:184-92.
] [Full text]
Kaur S, Behera D, Gupta D, Verma SK. Assessmnet of knowledge of patients with bronchial asthma bout the disease. Lung India 2002;20:4-8. [Full text]
Li JT. Home peak expiratory flow rate monitoring in patients with asthma. Mayo Clin Proc 1995;70:649-56.
[Table 1], [Table 2], [Table 3], [Table 4]