11 Nov CMO Jonathan Cartu Lectures – Self-Reported Barriers to Medical Treatment for Asthma
Abstract and Introduction
Background: Asthma is an extensive public health problem and inadequate disease control is not uncommon. Individuals’ self-perceived barriers to medical treatment for the entire treatment chain (from seeking care for symptoms to using a medicine) have seldom been studied for chronic diseases such as asthma. The aim of this study was to explore self-perceived barriers to medical treatment among individuals with asthma within the framework of AAAQ (availability, accessibility, acceptability and quality).
Methods: Individuals with asthma visiting the asthma nurse at a primary health care centre, and who currently had a prescription for anti-asthmatic medicines, were informed about the study. The nurse asked the persons for their consent to be contacted by an interviewer. The interview guide was constructed from the elements of AAAQ exploring self-perceived barriers to asthma treatment. Interviews were conducted in Swedish, English, Arabic and Persian. They were transcribed verbatim and a manifest content analysis was conducted.
Results: Fourteen interviews were conducted. There was a large variation in both age and reported number of years with asthma. Self-perceived barriers to asthma treatment were experienced throughout the whole treatment chain. Barriers that emerged were health care accessibility, perceived quality of care, beliefs about medicines, life circumstances, knowledge gap about asthma and medicines, practical obstacles to using medicines, and experiences with treatment. The self-perceived barriers cover all four elements of AAAQ, but there are also some barriers that go beyond those elements (life circumstances and practical obstacles to using medicines).
Conclusions: Self-perceived barriers among individuals with asthma cover the whole treatment chain. We want to highlight the inadequate information/education of patients leading to knowledge gaps about both disease and the effect of medicines, and also the perceived unsatisfactory treatment at the PHCC, which could partly be counteracted if patients know what to expect from health care visits.
Medical treatment of chronic diseases is far from optimal, leading to consequences for both the individual and society, one example being asthma. Asthma is an extensive public health problem, both in Sweden and world-wide. The prevalence is about 10% in Sweden. The disease requires prophylactic and/or acute treatment, and a large degree of self-management is involved. Previous research has reported that individuals with asthma have inadequate disease control[5,6] and a lower quality of life compared to people without asthma. Consequences for the society are increased use of health care services and indirect costs associated with unproductivity.
Individuals’ self-perceived barriers to medical treatment for the entire treatment chain (from seeking care for symptoms to using a medicine) have seldom been studied for chronic diseases such as asthma. Instead, barriers to treatment of chronic diseases have previously been studied from a health care perspective,[9,10] and some qualitative research has addressed barriers and facilitators to access to and utilization of health care services.[11â13] The identified barriers are both general (low income, communication problems, lack of knowledge about the health care system, disagreeable treatment by clinic staff),[9,11] and specific to a disease (underdiagnosing of men, unawareness of benefits of treatment, stigmatization, values and attitudes of health care provider).[9,10,12] Obstacles to adherence have also been discussed, both in general, and specifically for asthma treatment, for instance.[14â16] Still, there is a need for a more comprehensive picture of all barriers perceived by those in need of medical treatment that will provide tools for researchers, health care providers and policy makers to improve the management of chronic disease, and in this case, asthma specifically.
The right to the highest attainable standard of health (from here on, the Right to Health) is inscribed in many human rights treaties. The Right to Health encompasses the elements of availability, accessibility, acceptability and quality (AAAQ), which may be used as a framework to identify barriers over the entire treatment chain. Availability entails ensuring functioning health services in sufficient quantity, whereas accessibility entails ensuring that health services are non-discriminatory and physically and economically accessible, and that information is accessible. Acceptability implies that health services must be respectful of medical ethics, culturally appropriate, and gender and age sensitive, and that medical treatment must be explained in an understandable manner. Finally, quality requires that health facilities and medicines are scientifically and medically appropriate and of good quality. Schierenbeck et al. used the AAAQ as a framework in their analysis of mental health care in South Africa and found barriers pertaining to all four elements.
The aim of this study is to explore self-perceived barriers to medical treatment among individuals with asthma within the framework of AAAQ.