A Qualitative Investigation of the Treatment Goals of Adult Asthmatics

Steven, Karen (2000) A Qualitative Investigation of the Treatment Goals of Adult Asthmatics. MSc(R) thesis, University of Glasgow.

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Abstract

Qualitative research methods were used to study the treatment goals of adults with asthma in depth and in their social context and because patient asthma goals have not been extensively investigated. The author's role as a general practitioner may have affected the accounts given. As goals were not a dominant theme the hypotheses related to goals are discussed only briefly before concentrating on the reasons for having goals and for not having goals and the relationship of both states to the goals of the British Thoracic Society Guidelines. The implications of the study for asthma management are also discussed. Goals, motivation and behaviour form a rational framework but there are many barriers to goal formation. People are motivated to change their asthma management behaviour if they become aware that asthma is affecting their life. There are six influences on motivation. They are the effect of asthma on self- image, the value of the life experience affected, the experience of symptoms, the attitude to medication, the acceptance of the diagnosis of asthma and the perceived consequences of asthma. An asthma treatment goal will result if change is perceived to be possible. Behavioural change will occur unless there are practical difficulties or the person forgets. The relationship between patient goals, motivation and behaviour and the medical model is as follows. The goals of the British Thoracic Society (BTS) Guidelines are in concordance with the asthma management of some people without goals and with some people's goals. The reasons for concordance are an acceptance of both asthma and its treatment, coincidence, a shared concern about severe attacks, a shared estimation of the value of work and a shared view of the importance of controlling both symptoms and the use of medication. Lack of concordance with the goals of the BTS guidelines occurs because of differences in the estimation of the importance of asthma and a belief that it is possible to cure oneself of asthma. The literature review and the findings of the study discussed in this thesis have implications for the measures of quality proposed for use in asthma care, compliance as a model for asthma management behaviour, the potential for using goals in asthma care and the development and use of guidelines in asthma. Quality measures are based on the goals of the BTS guidelines rather than on patient goals. Compliance does not seem to be a useful model for asthma management behaviour because it does not take in to account the preferences or the experience of the individual or the dynamic nature of the disease. The evidence for increasing patient participation in health care using methods such as goals is as yet equivocal. At the moment, the importance of continuing to research the inclusion of the patient perspective into health care is based on the philosophy that it is the right thing to do. The development of the BTS guidelines has been limited by the relative lack of research evidence on patient goals, by the difficulty of appraising the quality of qualitative research using the existing criteria and by the use of "clinical" judgement rather than a consensus view of all stakeholders to inform the guidelines. The application of the BTS guidelines is also limited. Guidelines relate to the average person not the individual. There is evidence of differences between the perspective of the person with asthma and the prevailing guidelines for the management of asthma. Consideration should be given to including the perspective of individuals with asthma in the consultation and in the development and implementation of guidelines. (Abstract shortened by ProQuest.).

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Additional Information: Adviser: Jill Morrison
Keywords: Medicine, Epidemiology
Date of Award: 2000
Depositing User: Enlighten Team
Unique ID: glathesis:2000-76139
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 16:35
Last Modified: 19 Nov 2019 16:35
URI: http://theses.gla.ac.uk/id/eprint/76139

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