"Looking out for each other": a qualitative study on the role of social network interactions in asthma management among adult Latino patients presenting to an emergency department

Understanding non-recreational prescription medication-sharing behaviours: a systematic review

BACKGROUND

Prescription medication sharing refers to the lending or borrowing of prescription medications where the recipient is someone other than the person for whom the prescription is intended. Sharing prescription medication can cause significant harm. Adverse consequences include an increased risk of side effects, delayed health seeking, and severity of disease. Prevalence estimates vary across different populations and people's reasons for, and perceptions of risks from, sharing are poorly understood.

AIM

To better understand prescription medication-sharing behaviours and practices - specifically, the prevalence, types of medications, reasons, perceived benefits and risks, and factors associated with medication sharing.

DESIGN AND SETTING

This systematic review included primary studies in any setting, focusing on people who engage in medication sharing.

METHOD

Electronic databases were searched from inception of databases to February 2023.

RESULTS

In total, 19 studies were included. Prevalence of lifetime sharing ranged from 13% to 78%. All 19 studies reported that analgesics were the most shared, followed by antibiotics (n = 12) and allergy medication (n = 9). Common reasons for sharing were running out of medication (n = 7), cost (n = 7), and emergency (n = 6). Perceived benefits included resolution of the problem and convenience. Perceived risks included adverse drug reactions and misdiagnosis. Characteristics associated with sharing included age, female sex, having asthma, and unused medicines stored at home.

CONCLUSION

Findings suggest that medication-sharing behaviour is common and involves a range of medicines for a variety of reasons. Data on the prevalence and predictors of prescription medication sharing are inconsistent. A better understanding of non-modifiable and potentially modifiable behavioural factors that contribute to sharing is needed to support development of effective interventions aimed at mitigating unsafe sharing practices.

Understanding the journeys of patients with an asthma exacerbation requiring urgent therapy at a primary care clinic

BACKGROUND

Asthma is a significant health issue in primary care. We examined the journeys of patients with asthma exacerbations requiring urgent therapy at a primary care clinic in Singapore.

METHODS

Face-to-face semi-structured interviews were conducted with patients who received urgent therapy for asthma exacerbation at a primary care clinic. Data collected was used to construct themes.

RESULTS

Fifteen multi-ethnic adult patients were recruited. Participants cited treatment cost, underuse of preventer medication, difficulties attending routine asthma care due to work, and stigma as barriers to asthma control. Reasons for delay in seeking urgent care for asthma were: inability to access medical care out of hours, competing priorities, perception that an exacerbation was 'not serious enough', difficulty recognizing symptoms of asthma exacerbation, and being tired or despondent. Participants were triggered to seek care due to failure of reliever inhalers, duration of symptoms, sleep disturbance, inability to work, or advice from others. During an exacerbation, participants often initiated other self-management measures besides using reliever medication. This included over-the-counter medications and non-pharmacological interventions (e.g. drinking water). Of the 15 patients interviewed, only one stepped up preventer inhaler adequately, according to their Asthma Action Plan (AAP).

CONCLUSIONS

In caring for patients with asthma, primary care providers should address patients' asthma self-management skills, such as recognizing symptoms of asthma exacerbations and regular preventer use, and provide clear instructions on how to respond to asthma symptoms (AAP). Minimizing direct (medication and consultation fees) and indirect costs (loss of earnings and adverse impact on employment prospects) are also important considerations.

Barriers to implementing asthma self-management in Malaysian primary care: qualitative study exploring the perspectives of healthcare professionals

Asthma self-management is a crucial component of asthma management. We sought to explore healthcare professionals' (HCPs') perceptions on barriers to asthma self-management implementation in primary care. We recruited 26 HCPs from six public primary care clinics in a semi-urban district of Malaysia in 2019. The analysis was done inductively. HCPs described barriers that resonated with the "COM-B" behaviour change framework. Capability-related issues stemmed from a need for specific self-management skills training. Opportunity-related barriers included the need to balance competing tasks and limited, poorly tailored resources. Motivation-related barriers included lack of awareness about self-management benefits, which was not prioritised in consultations with perceived lack of receptiveness from patients. These were compounded by contextual barriers of the healthcare organisation and multilingual society. The approach to implementation of asthma self-management needs to be comprehensive, addressing systemic, professional, and patient barriers and tailored to the local language, health literacy, and societal context.

'Nesef Doctora'-When mothers are considered to be 'half-doctors': Self-medication with antibiotics and gender roles in the Arab society in Israel

This qualitative study focuses on self-medication with antibiotics as it relates to gender roles and traditions in the Arab society in Israel, a collectivist minority with defined traditional gender norms. Its findings draw on the analysis of 116 face-to-face interviews with 60 pharmacists, 27 primary care physicians and 29 community members, mainly mothers and unmarried women, from different geographical localities. The findings describe how mothers are assigned the role of the family health caretakers, expected to abide to a hierarchical power structure, and listen to the advice of 'senior mothers'. These expectations can lead to mothers self-medicating their children and themselves with antibiotics. Traditional constraints associated with sexuality were also found to compel unmarried women to self-medicate. The findings point to a duality of power in family relations: women submit to having limited power in traditional gender roles but are accorded power as medical experts in health-care decision-making. The study concludes with recommendations for considering sociocultural factors of hierarchy, traditions and collectivist orientation when researching self-care patterns and developing interventions to curtail antibiotics overuse. It also points to the importance of recognising pressures exerted on unmarried women and enabling them to use health-care resources in their community for managing sexual health.

A Scoping Review of International Barriers to Asthma Medication Adherence Mapped to the Theoretical Domains Framework

BACKGROUND

Internationally, adult asthma medication adherence rates are low. Studies characterizing variations in barriers by country are lacking.

OBJECTIVE

To conduct a scoping review to characterize international variations in barriers to asthma medication adherence among adults.

METHODS

MEDLINE, EMBASE, Web of Science (WOS), and CINAHL were searched from inception to February 2017. English-language studies employing qualitative methods (eg, focus groups, interviews) were selected to assess adult patient- and/or caregiver-reported barriers to asthma medication adherence. Two investigators independently identified, extracted data, and collected study characteristics, methodologic approach, and barriers. Barriers were mapped using the Theoretical Domains Framework and findings categorized according to participants' country of residence, countries' gross national income, and the presence of universal health care (World Health Organization definitions).

RESULTS

Among 2942 unique abstracts, we reviewed 809 full texts. Among these, we identified 47 studies, conducted in 12 countries, meeting eligibility. Studies included a total of 2614 subjects, predominately female (67%), with the mean age of 19.1 to 70 years. Most commonly reported barriers were beliefs about consequences (eg, medications not needed for asthma control, N = 29, 61.7%) and knowledge (eg, not knowing when to take medication, N = 27, 57.4%); least common was goals (eg, asthma not a priority, N = 1, 2.1%). In 27 studies conducted in countries classified as high income (HIC) with universal health care (UHC), the most reported barrier was participants' beliefs about consequences (N = 17, 63.3%). However, environmental context and resources (N = 12, 66.7%) were more common in HIC without UHC.

CONCLUSION

International adherence barriers are diverse and may vary with a country's sociopolitical context. Future adherence interventions should account for trends.

[The Disease Management Experience of Patients with Asthma: Grounded Theory Approach]

PURPOSE

The aim of this study was to develop a situation-specific theory to explain the disease management experience of patients with asthma.

METHODS

Twenty participants with asthma were selected using the theoretical sampling method. The data were acquired through in-depth interviews conducted from June to October 2018 and analyzed using the grounded theory approach of Strauss and Corbin.

RESULTS

In total, 69 concepts, 30 subcategories, and 13 categories were generated to explain the disease management experience of patients with asthma. The core category of the disease management experience of patients with asthma was 'management of the disease to prevent aggravation of symptoms over the lifetime'. The disease management process of asthma patients included three steps: the 'cognition phase', the 'adjustment phase', and the 'maintenance phase'. However, some patients remained in the 'stagnation phase' of disease management, which represents the result of the continual pursuit of risky health behavior. There were three types of disease management experiences among patients with asthma: 'self-managing', 'partially self-managing', and 'avoidant'.

CONCLUSION

This study shows that patients with asthma must lead their disease management process to prevent exacerbation of their symptoms. It is imperative to develop nursing strategies and establish policies for effective disease management of patients with asthma based on their individual disease management processes and types.

Prevalence and predictors of medicine saving and future prescription medicine sharing: findings from a New Zealand online survey

OBJECTIVES

To assess the prevalence of and factors predicting future prescription medicine sharing behaviours among adults in New Zealand (NZ). The prevalence and predictors of having leftover medicines at home and the relationship between medicine storing and sharing practices were also explored.

METHODS

An online, self-administered survey of a convenience sample of NZ adults was conducted. Logistic regression analysis was used to examine the association between explanatory and outcome variables.

KEY FINDINGS

Two hundred and thirty three participants took part, who were mostly members of patient support groups across NZ. A high prevalence of leftover medicine storing practices (72.4%), future prescription medicine borrowing (72.8%) and lending (68.7%) behaviours was documented. Over half of the participants (57.1%) had never received advice from healthcare providers about the safe disposal of medicines, and 79.7% reported never having received information about risks of medicine sharing from healthcare providers. In multivariate logistic regression analysis, high income, having asthma and having leftover medicines stored at home were found to be positive predictors of future medicine lending or borrowing intentions. Further, high income was a positive predictor of having leftover medicines stored at home. Conversely, those with hypertension would be less likely to lend or borrow medicines.

CONCLUSIONS

The high prevalence of leftover medicine storing practices and future medicine sharing intentions among adults in NZ suggests it may be beneficial to provide patient and public education about appropriate use of prescribed medicines and safe medicine disposal procedures. Further research is needed to elicit effective strategies to reduce leftover medicines and unsafe medicine sharing practices.

A Moderated e-Forum for Adults With Cardiovascular Disease: Usability Study

Background

Self-care behaviors are commonly prescribed to manage both cardiovascular disease and hypertension to reduce modifiable risk factors and improve quality of life. Nevertheless, long-term adherence to self-care recommendations for cardiac patients has been problematic. In cardiac patients, moderated online forums have been found to be particularly useful in supporting maintenance of heart-healthy diet and fewer hospital visits. As such, we developed the e-Forum, a Web-based moderated forum designed to promote continued user engagement and long-term self-care adherence.

Objective

The objective of this study was to assess the usability of the user interface for the newly designed e-Forum. In addition to overall user satisfaction, we obtained feedback from our target users on the key features of this newly developed interface.

Methods

An iterative design tested the usability of the e-Forum. On the basis of the user feedback, adjustments were made to the design of our e-Forum, and these changes were then tested in the succeeding group. Participants were recruited from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network. After consenting to participate in our study, patients were asked to complete a set of goal-oriented tasks and a feedback interview for the e-Forum. A content analysis of the transcripts from the set of goal-oriented tasks and feedback interviews identified several themes, including general feedback and comments regarding 3 key areas of the e-Forum: layout, navigation, and content.

Results

Overall, 13 cardiac patients (aged 32-81 years) participated in 3 rounds of testing. Participants across all 3 rounds were highly satisfied with our e-Forum and indicated that they would find such a forum useful in managing their health. Expressions of overall satisfaction with the e-Forum and positive comments regarding layout increased between the initial and the final round. As improvements were made to the e-Forum based on participant feedback, potential barriers, negative comments related to the content, and the number of navigation errors decreased between rounds 1 and 3.

Conclusions

We found evidence to support the usability of the user interface for our e-Forum. These results indicate that the e-Forum will likely be a successful tool to support an online community of cardiac patients in their efforts to sustain long-term lifestyle behavior change.

Modifiable risk factors for prescription medicine sharing behaviours

BACKGROUND

Prescription medicine sharing has been defined as giving one's own medicine to someone else (lending) or taking someone else's medicine (borrowing). Medicines can be shared for non-medical purposes (recreational sharing or drug abuse) or for their intended therapeutic benefits (non-recreational sharing, e.g. sharing antibiotics to self-treat); the latter is the focus of this research. Limited research evidence is available about modifiable risk factors for non-recreational medicine sharing and addressing this issue was the main aim of this research.

METHODS

An online, cross-sectional survey design was used. The study population comprised a convenience sample of 233 adults, who were primarily recruited through patient support groups across New Zealand. Principal component analysis was used to develop scales assessing attitudes toward medicine lending and borrowing. Logistic regression was used to examine the relationship between explanatory (demographics, medical conditions, and attitudes towards medicine sharing) and outcome (medicine sharing behaviours) variables.

RESULTS

Half of the study participants reported ever borrowing/lending medicines, and approximately a third of participants reported borrowing/lending in the past year. Modifiable risk factors associated with an increased risk of medicine borrowing behaviour were having more difficulty with accessing medicine ('access-related issue'), stronger 'emotional beliefs about borrowing', and greater 'concern about missing doses.' Greater 'concern for the wellbeing of others' and stronger 'beliefs about the benefits and safety of lending' were associated with an increased risk of medicine lending behaviour. Those with a higher 'perceived risk of harm' were less likely to borrow or lend medicines.

CONCLUSIONS

This research expands the current knowledge of medicine sharing by examining underlying behavioural factors which predict sharing behaviours and that can be modified by interventions. This research suggests using multifaceted interventions which consider health status, behavioural, and psychosocial factors, as these appear to contribute most to medicine sharing.

Using the Behaviour Change Wheel to explore potential strategies for minimising harms from non-recreational prescription medicine sharing

INTRODUCTION

Non-recreational sharing of prescribed medicines can have positive outcomes under some circumstances, but can also result in negative health outcomes. This paper describes a theoretically underpinned and systematic approach to exploring potential interventions to reduce harm.

METHODS

Individual, semi-structured, face-to-face interviews were conducted with purposively sampled pharmacists (n = 8), doctors (n = 4), nurses (n = 6) and patients (n = 17) from Auckland, New Zealand. Thematic analysis of suggested interventions was undertaken, and these were linked to relevant intervention functions of the Behaviour Change Wheel (BCW). Analysis of previously defined factors influencing sharing were mapped onto the "Capability, Opportunity, Motivation - Behaviour" (COM-B) model of the BCW.

RESULTS

COM-B analysis of the factors influencing sharing behaviour revealed: (i) 'Capability'-related factors, such as patient misconceptions about the safety of certain medicines, forgetting to refill or to carry around own medicines, and lack of knowledge about safe disposal of leftover/unused medicines; (ii) 'Opportunity'-related factors included lack of access to health facilities, lack of time to see a doctor, linguistic and cultural barriers, lack of information from healthcare providers about risks of sharing, and having leftover/unused medicines, and (iii) 'Motivation'-related factors included altruism, illness denial, embarrassment about seeing a doctor, not carrying around own medicines, habit, and fear of negative health consequences from missing a few doses of medicines. Five intervention functions of the BCW appear to be the most likely candidates for targeting the factors which relate to medicine sharing. These are education, persuasion, enablement, environmental restructuring and restriction.

CONCLUSIONS

A variety of personal and external factors which influence sharing behaviours were identified, and the BCW provided a means by which theoretically underpinned interventions to reduce potential harms from this behaviour could be proposed. The findings can help with the design of approaches to reduce harm associated with non-recreational medicine sharing.

Barriers and facilitators of effective self-management in asthma: systematic review and thematic synthesis of patient and healthcare professional views

Self-management is an established, effective approach to controlling asthma, recommended in guidelines. However, promotion, uptake and use among patients and health-care professionals remain low. Many barriers and facilitators to effective self-management have been reported, and views and beliefs of patients and health care professionals have been explored in qualitative studies. We conducted a systematic review and thematic synthesis of qualitative research into self-management in patients, carers and health care professionals regarding self-management of asthma, to identify perceived barriers and facilitators associated with reduced effectiveness of asthma self-management interventions. Electronic databases and guidelines were searched systematically for qualitative literature that explored factors relevant to facilitators and barriers to uptake, adherence, or outcomes of self-management in patients with asthma. Thematic synthesis of the 56 included studies identified 11 themes: (1) partnership between patient and health care professional; (2) issues around medication; (3) education about asthma and its management; (4) health beliefs; (5) self-management interventions; (6) co-morbidities (7) mood disorders and anxiety; (8) social support; (9) non-pharmacological methods; (10) access to healthcare; (11) professional factors. From this, perceived barriers and facilitators were identified at the level of individuals with asthma (and carers), and health-care professionals. Future work addressing the concerns and beliefs of adults, adolescents and children (and carers) with asthma, effective communication and partnership, tailored support and education (including for ethnic minorities and at risk groups), and telehealthcare may improve how self-management is recommended by professionals and used by patients. Ultimately, this may achieve better outcomes for people with asthma.

Can Social Integration and Social Support Help to Explain Racial Disparities in Health Care Utilization Among Men with Diabetes?

OBJECTIVE

Discovering the mechanisms through which racial and ethnic background influence health is critical to better understanding racial disparities in health among men with a diabetes diagnosis. The present study examines whether social support and social integration mediate or buffer the relationship between race and health care utilization among U.S. men.

METHOD

This study used a sub-sample from the 2001 National Health Interview Survey that included Latino, African American, non-Latino White men living with self-reported diabetes (n = 7,148).

RESULTS

Findings revealed that African American men with high levels of social integration were less likely to forego care (OR = 0.234, [CI = 0.053,1.045]). Also, African American men who did not attend church had higher odds of foregoing care (OR = 0.222, [CI = 0.110,0.448]).

CONCLUSIONS

The effect of social networks operate differently for African American men with diabetes compared to non-Latino white men. Identifying racial differences in the influence of social networks on health will assist in developing interventions that may help to decrease gender and race gaps in health for men with diabetes.

Prescription medicine sharing: exploring patients' beliefs and experiences

Background

Prescription medicine sharing has been defined as the lending of medicines (giving prescription medicines to someone else) or borrowing of medicines (being given and using a medicine prescribed for another person). This qualitative study explored the views of patients, to elicit information regarding factors influencing medicine sharing behaviours, their experiences of the consequences of prescription medicine sharing, and their risk assessment strategies when deciding to share.

Methods

One-on-one, face-to-face, semi-structured interviews were carried out in Auckland, New Zealand between September 2013 and August 2014 with 17 patients, purposively sampled to provide information from different socio-demographic backgrounds. The interviews were audio recorded, transcribed verbatim and analysed using a general inductive approach. The study received ethical approval, and all interviewees provided written informed consent.

Results

Findings were captured within five overarching themes: types of shared medicines; perceived benefits of sharing medicines; negative experiences of sharing; factors influencing sharing behaviours; and risk assessment strategies. Participants reported that sharing helped them to avoid treatment costs and the inconvenience associated with medical visits such as booking appointments. Conversely, unanticipated side effects, allergies, and taking inappropriate medicines were the main adverse consequences of sharing. Altruism, limited access to medicines/health services, sociocultural factors, and having unused prescription medicines were factors influencing sharing behaviours. Participants reported assessing the safety of sharing a medicine primarily based on symptom matching, past illness experiences, and knowledge about the medicines.

Conclusions

This study enriches previous survey findings, by providing insight into patients' reasons for medicines sharing. Healthcare providers should consider asking their patients about any medicines they have shared and their future sharing intentions, in order to use the opportunity for discussing safer sharing practices, without promoting the behaviour. The findings are helpful for informing the development of potential interventions and targeted educational messages about safe medicine use for patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s40545-016-0075-5) contains supplementary material, which is available to authorized users.

Unmet Needs at the Time of Emergency Department Discharge

OBJECTIVES

Emergency department (ED) discharge requires conveying critical information in a time-limited and distracting setting. Limited health literacy may put patients at risk of incomplete comprehension, but the relationship between discharge communication needs and health literacy has not been well defined. The goal of this study was to characterize the variation in needs and preferences regarding the ED discharge process by health literacy and identify novel ideas for process improvement from parents and patients.

METHODS

This was an in-depth qualitative interview study in two EDs using asthma as a model system for health communication. Adult patients and parents of pediatric patients with an asthma exacerbation and planned discharge were enrolled using purposive sampling to balance across literacy groups at each site. Interviews were audiotaped, transcribed, coded independently by two team members, and analyzed using a modified grounded theory approach. Interviews were conducted until thematic saturation was reached in both literacy groups at each site.

RESULTS

In-depth interviews were completed with 51 participants: 20 adult patients and 31 pediatric parents. The majority of participants identified barriers related to ED providers, such as use of medical terminology, and systems of care, such as absence of protected time for discharge communication. Patients with limited health literacy, but not those with adequate literacy, identified conflicting information between health care sources as a barrier to successful ED discharge.

CONCLUSIONS

Participants across literacy groups and settings identified multiple actionable areas for improvement in the ED discharge process. These included the use of simplified/lay language, increased visual learning and demonstration, and the desire for complete information. Individuals with limited literacy may particularly benefit from increased attention to consistency.

Characteristics and prognosis of near-fatal asthma exacerbations

BACKGROUND

Asthma remains a major public health concern because of its high prevalence and the costs it generates. Near-fatal asthma (NFA) episodes represent the most severe forms of the disease after fatal asthma with significant variations in their incidence between different populations.

OBJECTIVE

To analyze the episodes of NFA over a period of 11 years in the hospital.

METHODS

The authors retrospectively reviewed all admissions due to asthma exacerbation in our hospital between 2000 and 2010 for patients over 18 years of age.

RESULTS

The study included 400 NFA episodes of 285 patients (74% women; mean age 66 years). Of these patients, 228 (80%) had a single episode of NFA and 57 had more than 1 episode during the study period. The authors observed no clear upward or downward trend during the study period. Readmitted patients had more comorbidities, poorer lung function, more severe forms of asthma and more admissions in the year before the index admission. There was a mortality rate of 3.1%. More than 20% of patients were not given controller treatment and more than 40% of patients were not treated with inhaled corticosteroids (ICS).

CONCLUSIONS

NFA episodes are still prevalent in the population of patients with asthma. Reasons for this could be related to improper management in the stable phase, as suggested by the low rate of patients treated with ICS. It also seems necessary to optimize patient management during hospitalization because stays appear prolonged in comparison with studies in other countries.