Communication and understanding keys to asthma treatment
Cultural and socio-economic factors can be obstacles to asthma care
Despite increased asthma education efforts, state-sponsored asthma
management initiatives, and safe and effective medications for
prevention and control, asthma continues to be the most prevalent
chronic childhood disease in the U.S. In New England, it affects
one in eight children.
Healthcare providers can often experience frustration about the
patient and patient families’ lack of adherence to medical advice
regarding medications or other asthma management measures. Many
asthma symptoms and most asthma-related hospitalizations and emergency
room visits could be avoided with basic preventive care, but patients
and their families often under-utilize the resources available
to them, making their asthma a far more serious condition.
The problem may be due in large part to cultural or socio-economic
issues. A recent study by the New England Asthma Regional Council
confirmed that asthma and its consequences continue to disproportionately
affect the poor, as well as black and Hispanic families. According
to the study, children from families with a household income of
less than $25,000 are almost twice as likely to have asthma than
children from families with household incomes of more than $75,000.
In addition, asthma rates are 50 percent higher in black and Hispanic
families than in white families.
With the highest incidence of asthma in those cultures and socio-economic
levels, healthcare providers have a responsibility to consider
the cultural influences and lifestyle situations that may impact
a family’s willingness or ability to participate in preventive
care, says Amy Burack, RN, Community Asthma Program
manager at Children’s Hospital Boston.
“Clinicians should be aware of the cultural, financial and environmental
obstacles that asthma patients may face so they can promote better
communication and trust between the patient and provider,” says
Burack.
Obstacles to treatment and prevention can include poor and old
housing that may be infested with mold, mildew, and cockroach
droppings, which have been found to be a particular threat to
children with asthma. Often the lower-income patient’s obstacle
to preventive care is a lack of transportation to the doctor or
pharmacy, or a lack of health insurance or funds to pay for medications
and follow-up appointments. Due to financial hardship, many families
seek healthcare only when they have an emergency.
“When poverty is a factor and their children appear to be well,
families often have little choice but to spend money on food or
other necessities, rather than medications or co-pays,” says Beth
Klements, MS, APRN, BC, asthma nurse specialist in Medicine
Patient Services at Children’s. “So it’s up to healthcare providers
to let parents know that it’s vital to maintain daily control
of asthma, especially when their child is feeling well and not
displaying symptoms.”
| Talking about asthma
- Use simple, clear language
- Repeat important messages
- Communicate important information in more than one
way
- Give patients and their parents written material in
the family’s primary language
- Ask if anything about the asthma management plan concerns
them
- Ask what might make it easier for them to follow the
prescribed management plan
- Emphasize the need for preventive care, even when symptoms
are not present
|
Cultural issues can also stand in the way of adequate care. In
some cultures, people with a chronic illness like asthma are viewed
as weak, which discourages parents from seeking appropriate care.
In addition, some cultural traditions, such as burning incense
or using herbs to treat illnesses, may not be embraced by Western
medicine, but may be an integral part of a family’s culture.
“It’s important that healthcare providers show respect and regard
for the cultural traditions that motivate these families, but
strike a balance with Western medical treatments,” Burack says.
For instance, in some Latino cultures, asthma is viewed as a
“cold” illness, treated by hot liquids, so physicians can suggest
taking asthma medications with hot tea or broth to maintain patients’
comfort level regarding medical treatment.
Education during an office visit can be time-consuming, but will
generally improve adherence to treatments. Taking an extra minute
or two to ask families what they understand about asthma, and
to learn what their environment and situation are like can be
helpful in determining the best course of treatment. At each visit
talk about the importance of preventive asthma care using simple,
clear language. Give patients written material in the family’s
primary language for reinforcement. Promote family involvement
and ask the family and patient if they have any concerns about
adhering to treatment. Ask what would make it easier for them
to follow the prescribed management plan. “Develop a partnership
with the patient and family,” Burack says, “and at every visit
emphasize that there will be a next visit and further refine the
responsibilities of both patient and provider. With communication
sensitive to the unique issues that face poor and urban children
with asthma, pediatricians may be able to decrease the incidence
of asthma-related emergency room visits and hospitalizations each
year.”
