A qualitative study of the barriers facing primary healthcare professionals in identifying occupational asthma

Abstract

Introduction: Occupational asthma (OA) remains under-recognized, leading to poor health and employment outcomes for affected workers. Healthcare professionals (HCPs) in primary care and acute hospitals rarely enquire about asthma symptoms and work, with poor knowledge, training, and time resource cited as explanations; this has not been studied in depth. We aimed to explore beliefs and behaviours amongst primary HCPs, which may present barriers to identifying OA.

Methods: Using a phenomenological qualitative approach, we undertook semi-structured interviews with HCPs from urban and rural practices in the West Midlands, UK. All interviews were held face to face and captured using a digital Dictaphone; audio recordings were transcribed professionally. GW undertook open coding of the data and thematic analysis, with CB acting as a critical friend.

Results: 11 HCPs (7 GPs, 4 practice nurses) with a range of experience (4-34 years) were interviewed. Four themes impacting on whether HCPs were likely to suspect and investigate OA were identified: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. HCPs described limited subject-specific formal education at any career stage, limited experience, and perceived low occurrence of OA in their practice. Extrinsic factors limiting enquiry were: continuity of care, time, workload, guideline use, external targets, and referral pressures.

Conclusion: Individual practice, and the organisation and service delivery of UK primary care, may impede the early identification of OA. Educational interventions should target all stages of training and professional development.