The role of self-efficacy and locus of control in asthma-related needs and outcomes: a cross-sectional study.

Objective: This study sought to identify psychological resources, which are associated with improved asthma outcomes. Methods: A total of 205 patients who reported physician-diagnosed asthma were surveyed between September 2017 and March 2018. Psychological resources included self-efficacy (i.e. the belief in one's capabilities to organize and execute required behavior [SE]; assessed by the Short Scale for Measuring General Self-Efficacy Beliefs), and internal and external locus of control (i.e. one's beliefs about whether a given event is the result of one's behavior or of forces outside one's control [LoC]; Scale for Internal External Locus of Control-4). Outcome variables included asthma control (Asthma Control Test), asthma-related quality of life (QoL; Asthma Quality of Life Questionnaire-Sydney) and patient needs (Patient Needs in Asthma Treatment Questionnaire). Associations were estimated by linear regressions. Results: We observed that higher self-efficacy and internal LoC scores, but lower scores on the external LoC subscale were associated with improved asthma control (SE: ß = 0.19, p = 0.01; internal LoC: ß = 0.17, p = 0.02; external LoC: ß = -0.18, p = 0.01), better asthma-related QoL (SE: ß = -0.38, p < 0.01; internal LoC: ß = -0.40, p < 0.01; external LoC: ß = 0.46, p < 0.01) and less unmet needs (SE: ß = -0.16, p = 0.02; internal LoC: ß = -0.18, p < .01; external LoC: ß = 0.32, p < 0.01). Conclusions: Our study provides novel evidence on psychological resources among patients with asthma, which are associated with improved asthma outcomes.

The Patient Needs in Asthma Treatment (NEAT) questionnaire: Further evidence on its psychometric properties.

BACKGROUND: Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change, and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest study (Study 2) among patients self-reporting physician-diagnosed asthma. METHODS: In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire-Sydney (AQLQ-S), and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018. RESULTS: Concurrent validity: In linear regressions, unmet patient needs were cross-sectionally associated with poorer asthma control (ß = -0.21; P = 0.01), asthma-related quality of life (QoL) (ß = 0.31; P < 0.01), and treatment satisfaction (ß = -0.59; P < 0.01). Predictive Validity: Higher unmet needs at baseline predicted worse treatment satisfaction at follow-up (ß = -0.28; P < 0.01), but neither asthma control nor asthma-related QoL. Responsiveness to change was demonstrated by linear regressions of changes in the total NEAT score and changes in AQLQ-S (ß = 0.21; P < 0.01) and treatment satisfaction (ß = -0.36; P < 0.01). MIC: Patients whose NEAT score increased between baseline and follow-up by the identified MIC (0.301) reported lower treatment satisfaction at follow-up (ß = -0.17; P = 0.01). Test-retest reliability was demonstrated by correlations between NEAT baseline and follow-up scores (eg, intra-class correlation coefficients for total score = 0.78). The SDC (0.384) was slightly larger than MIC. CONCLUSION: NEAT is a promising tool for assessing asthma treatment needs.

Development and initial Experience of an online Exchange Platform on Sex and Gender Aspects in Medicine: "GenderMed-Wiki".

Goal: Knowledge about sex/gender aspects in medicine is often lacking, even though this serves as base for individualized patient-centered care. Thus we developed an online exchange platform on sex and gender aspects in medicine: "GenderMed-Wiki" [www.gendermed-wiki.de]. This was funded by the German Federal Ministry of Education and Research (BMBF; FKZ: 01FP1506). Our goal is to facilitate the integration of sex and gender in all areas of medicine. Therefore we evaluated if "GenderMed-Wiki" is suitable to provide knowledge on sex and gender aspects in medicine adequately. Methods: Qualitative evaluation of "GenderMed-Wiki" was done 6 months after project start by 4 focus groups with a total of 30 participants (students, lecturers, physicians, and the public). The discussions in each focus group were minuted, requirements pooled and new categories derived inductively. After further optimization of the platform a quantitative survey was done by an online questionnaire (SoSci Survey). 149 students of the medical faculties of Muenster and Duisburg-Essen (as well as students of dentistry from the medical faculty of Muenster) participated (return rate of 3.3%). Evaluation of the content of the articles was done by assessing three professional articles: Sex/gender and medicine (both study courses medicine and dentistry), depression (medicine only) and periodontitis (dentistry only). The results were reported in relative and absolute frequencies and associations were assessed by Chi-Quadrat-tests. Results: Four categories which needed further optimization were deducted from the responses given by our focus groups prior to evaluation: aspects related to content, technical requirements, usability of the platform and legal challenges. Most of the students found "GenderMed-Wiki" to be informative, however they didn´t think it to be relevant for their current studies. In contrast, many thought that the platform may be useful when working as physicians. Students who reported that topics related to sex and gender were not of importance to them, evaluated the platform more neutrally and answered questions related to sex/gender in depression more often incorrectly. Conclusions: Focus groups are a useful approach to identify necessary changes in projects in a systematic way. After further optimizations, "GenderMed-Wiki" seems to be suitable to facilitate the integration of sex/gender into medical teachings. It is of importance, however, to change the attitude of students towards sex/gender sensitive medicine (e.g. by integration into the medical curriculum), since this influences strongly how this platform is perceived and how someone deals with its contents.