Assessment of Practical Knowledge of Self-Management of Acute Asthma

doi:10.1378/chest.109.1.86

Chest

Volume 109, Issue 1, January 1996, Pages 86-90

https://doi.org/10.1378/chest.109.1.86 Get rights and content

Aims

To develop an instrument for the measurement of, and to determine the level of, practical knowledge of self-management of acute asthma.

Methods

Eighty patients with moderate/severe asthma attending a hospital-based asthma clinic responded to an interviewer-administered questionnaire. Subjects were asked to describe the action they would take in response to each of two hypothetical evolving attacks: (1) one of gradually increasing severity and (2) the other developing rapidly. Responses were scored according to the appropriateness of actions taken relevant to the stage of the attack. Transcripts of the responses were scored independently by three of the investigators according to a system based on Thoracic Society of Australia and New Zealand (TSANZ) and British Thoracic Society (BTS) consensus statements on asthma management. A 25-point scale was used on which 0 represented a total lack of appropriate responses and a score of 25 was an optimal response. Results: Interrater and intrarater reliability were excellent. Mean (±SD) scores for the slow and rapid onset attacks were 12.8±4.0 and 13.9±4.8, respectively. The scores for the two scenarios were predicted by each other (p=0.002) and by the interviewer's rating of asthma management knowledge (p=0.0004, p=0.0001), but not by age, sex, race, previous asthma morbidity, depression, or anxiety. In both scenarios, most patients indicated that they would increase inhaled β-agonist (85% for slow-onset scenarios and 94% for rapid-onset scenarios, respectively) and use their action plan and/or seek urgent medical advice at an appropriate time (74% and 70%). Although some would measure peak expiratory flow (PEF) initially (54% and 30%), only a minority would continue to monitor PEF in the context of worsening acute asthma (30% and 24%). When a severe life-threatening situation was described, only 50% and 64%, respectively, indicated that they would call emergency services.

Conclusions

Scenarios describing hypothetical asthma attacks are a useful and reproducible method of assessing practical knowledge of self-management of acute asthma. Patients presented with scenarios frequently made errors in their hypothetical responses. The errors made with scenarios, which parallel errors reported in real clinical situations, occurred despite the fact that this patient population had received considerable education and training about how to manage asthma. Most indicated they would not monitor PEF even in an exacerbation of asthma and would not call emergency services despite life-threatening asthma. These scenarios may allow us to explore the gap between knowledge about treatment and actual practice, and perhaps to help close that gap and thus reduce asthma morbidity and mortality.

Section snippets

Patients

Subjects aged 14 years and older and diagnosed as having asthma, on the basis of demonstrable reversible airflow obstruction, were recruited from a hospital-based asthma clinic. The lower age limit is the age at which patients are transferred to adult clinics and are considered to be of sufficient maturity to take responsibility for their own health. The asthma clinic is located at a major public hospital that is the regional center for respiratory medicine.

Although general practitioners may

Subjects

Eighty subjects aged between 14 and 76 years (mean=41.2 years) were recruited from the asthma clinic. Forty-four percent were male. Eighty-nine percent were European and 9% were Maori or Pacific Islanders. Subjects had attended the clinic an average of 9.8 occasions, 3.8 in the previous year. On each occasion, they had received instruction from a physician and the nurse educator and all had received a written action plan, a peak flowmeter, and instructions on PFM. Virtually all had

DISCUSSION

We have developed scenarios to assess practical knowledge of asthma self-management. Despite considerable education, our patients were surprisingly poor at applying knowledge to action in this scenario situation. Furthermore, the deficiencies in conceptional plans reflected in the suboptimal responses to scenarios correspond surprisingly well with the types of self-management deficiencies that are encountered in actual clinical medicine. The data suggest that scenarios may be a tool that can be

Asthma Knowledge

Hypothetical Asthma Attacks (Based on Sibbald⁴)

Now I am going to ask you some questions about the kind of experiences that some people with asthma may have and I would like you to talk about the sorts of things you would do if they were to happen to you.

I will begin by describing to you a short scene about a particular situation. Then I will ask you some questions and then go on to the next scene.

Some of your answers may cover all the stages. I must read you every scene so if that happens just

ACKNOWLEDGMENTS

We thank the staff of Asthma Clinic for their patience and tolerance, all the subjects who participated for their time and effort, and Kathy Gallimore, Josephine Ratnasabapathy, and Margaret McKinlay for their assistance in preparing the manuscript.

REFERENCES (13)

KolbeJ et al.
Influences on trends in asthma morbidity and mortality: the New Zealand experience
Chest
(1994)
O'ReillyP et al.
Role of support networks in maintenance of improved cardiovascular health status
Soc Sci Med
(1989)
Bauman A. A meta-analysis of asthma patient education programmes [abstract]. Proceedings of the Thoracic Society of...
GarrettJ et al.
Prospective controlled evaluation of the effect of a community-based education centre: a multiracial working class neighbourhood
Thorax
(1994)
SibbaldB
Patient self-care in asthma
Thorax
(1989)
TaylorGH et al.
A tool for measuring the asthma self-management competency of families
J Psychosom Res
(1992)

There are more references available in the full text version of this article.

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Élaborer un questionnaire mesurant les connaissances et les compétences en rapport avec la sécurité d’emploi des biothérapies chez les patients.
Processus en trois étapes : (1) un groupe pilote composé de dix rhumatologues, un pharmacien et deux paramédicaux a élaboré une liste exhaustive des compétences en rapport avec la sécurité d’emploi. À travers un exercice Delphi de trois tours incluant le groupe pilote, 14 patients sous biothérapies et 14 autres professionnels de la santé, la liste des compétences a été réduite ; (2) une série correspondante de questions et de situations cliniques avec des questions à choix multiple a été créée ; (3) une validation préliminaire a été réalisée en comparant le questionnaire à l’opinion des médecins sur les compétences, et la validité a été évaluée.
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Un outil simple (questions à choix multiple) et valide évaluant un certain nombre de compétences en termes de sécurité a été développé. Cet outil pourrait être utile afin de détecter les besoins ultérieurs en matière d’éducation concernant la sécurité des biothérapies, et afin d’évaluer l’efficacité d’interventions dans le domaine de l’éducation thérapeutique.

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: Supported by a grant from the Health Research Council of New Zealand.

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Chest

Clinical Investigations: AsthmaAssessment of Practical Knowledge of Self-Management of Acute Asthma

Aims

Methods

Conclusions

Section snippets

Patients

Subjects

DISCUSSION

Asthma Knowledge

ACKNOWLEDGMENTS

Chest

Soc Sci Med

Prospective controlled evaluation of the effect of a community-based education centre: a multiracial working class neighbourhood

Thorax

Patient self-care in asthma

Thorax

A tool for measuring the asthma self-management competency of families

J Psychosom Res

Clinical Investigations: Asthma
Assessment of Practical Knowledge of Self-Management of Acute Asthma