Exploring chronic airways disease patients' perspectives on self-management topics.

OBJECTIVES: In this study, we explored chronic airways disease (CAD) patients' responses to health literacy (HL) communication domain questions within disease self-management scenarios, as part of a larger CAD HL measurement tool development study. METHODS: Adult asthma and chronic obstructive pulmonary disease (COPD) patients from specialty care respiratory clinics were initially presented with realistic disease management scenarios and asked to share information they would communicate. Participants' responses were grouped into response categories that were reviewed and verified by key informants. A new cohort of CAD patients then responded to the same scenarios and had their answers placed into the developed response categories by trained interviewers. RESULTS: 19 initial stage participants' responses informed response categories for the following self-management topics: Inhaler Use (n = 20); Prednisone Use (n = 30); Flu (Influenza) (n = 35); and Weather Forecasting & Air Quality Index (n = 29). 141 participants' responses were categorised during the second stage. CONCLUSIONS: Specialty care CAD patients displayed an understanding of key information to communicate across disease self-management topic. Our two-step, patient-driven approach may interest researchers investigating health-related communication from patients' perspectives. PRACTICE IMPLICATIONS: Findings may illuminate potential areas to investigate communication gaps among CAD patients; further investigation is warranted among non-specialty care patients.

A conceptual model of functional health literacy to improve chronic airway disease outcomes.

BACKGROUND: Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework. METHODS: Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist's on the ideal functional HL skills for asthma and COPD patients. RESULTS: Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains. CONCLUSIONS: We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients. TRIAL REGISTRATION: NCT01474928 - Date of registration: 11/26/2017.

Assessing factors influencing smoking and smoking cessation within Chinese communities in the Greater Vancouver Area: A qualitative exploratory study.

INTRODUCTION: The prevalence of smoking is high within Chinese-Canadian communities and there is a lack of culturally and linguistically appropriate smoking cessation resources and services. We aimed to ascertain factors affecting smoking and smoking cessation from the perspectives of current smokers and key informants. METHODS: As part of a multistage mixed-methods study taking place from January 2013 to June 2014, a qualitative exploratory study design was conducted applying a community-based participatory research approach. Focus groups and interviews were conducted with adult (aged ≥19 years) Chinese-Canadian current smokers (≥5 cigarettes per day for the past 30 days) and interviews were held with key informants in Vancouver, Canada. A constant comparison method was applied to code data, and an inductive approach was used to identify emergent themes. RESULTS: In all, 35 smokers from the target communities (11 female, 24 male) participated in 4 focus group sessions and 17 key informants (14 female, 3 male) were individually interviewed. Internal and external factors influencing smoking onset, continuation, and cessation from the perspectives of smokers and key informants were identified. Male smokers thought that the most influential factor influencing smoking initiation was social pressure, while female smokers thought that it was stress. Female smokers reported refraining from seeking cessation assistance due to a perceived negative image of female smokers within the community. Both key informants and participants indicated that involving friends and family in the quitting process may help to motivate smokers. CONCLUSIONS: Smokers from Chinese-Canadian communities may benefit from linguistically appropriate and culturally relevant smoking cessation interventions that consider prevailing attitudes, perceptions, and beliefs. The knowledge gained may inform the development of future smoking cessation programs and resources for the target community, while our approach may be applicable to other ethnocultural or immigrant communities.