Dailah, HGH
2020,
A self-management program for adults with asthma in Saudi Arabia
, PhD thesis, University of Salford.
Abstract
Introduction
Globally, asthma is one of the major non-communicable diseases. Across the world, there are approximately 235 million people with asthma; including approximately 4% of the adult population in Saudi Arabia. Asthma patients within the rural areas of Saudi Arabia such as Jizan face additional challenges in relation to accessing asthma treatment including; lack of health professional expertise, low numbers of hospitals and distance from hospitals. The Saudi Initiative for Asthma (SINA) guidelines recommend asthma education but there is little evidence of how these guidelines should be translated into practice and patients within the region have a low awareness of available support and low levels of education preventing benefit from any asthma education. A systematic review highlighted no studies relating to educating adult asthmatics had taken place in Saudi Arabia, but provided guidance on effective programs and methods that had been implemented elsewhere. Therefore, this study aimed to develop and implement an asthma self-management adult program that was relevant to the Saudi context and culture. The program was evaluated to determine its impact on asthma control, patient self-management, asthma knowledge, and emergency department visits. Participant views were sought on how the program had worked in practice.
Methods
An Asthma Self-Management Education Program (ASMEP) was developed using evidence from a systematic review, theoretical constructs and collaboration with health professional and patient stakeholders. The intervention involved a two day program supplemented by a booklet, delivered by nurses to gender segregated groups. An explanatory sequential complementary mixed method design was employed for evaluation. The quantitative element used a quasi-experimental pretest-postest design. A range of validated questionnaires were used to collect data before the intervention and at 3 months after the intervention for an intervention and control group and at 6 months for the intervention group to see if intervention effects were maintained. Demographic variables analysis was conducted to provide comparisons with respect to age, gender, education, and employment. Semi-structured interviews were conducted with eight patients to gain the patient’s perspective on the barriers and facilitators of the intervention. Thematic analysis used to extract themes, sub-themes, and keywords for determining the common patterns in data.
Findings
A total of 125 patients participated in the study, including 62 patients in the intervention group and 63 in the control group. Quantitative data analysis revealed that the asthma educational program (ASMEP) improved asthma knowledge, patient activation, asthma control, and asthma self-management in the intervention group, although there were some demographic variations. There were significantly lower number of visits by patients to the emergency department after accessing the education.
The findings of the qualitative component documented and uncovered the different facilitators and barriers which affected the implementation and effectiveness of the educational program in the Saudi Arabia. Patients valued the program, and the role played by hospital staff in promoting it, but more expertise is needed to improve and expand delivery.
Conclusion:
The thesis provides a unique and original evidence base on which educational resources in Saudi Arabia can be prepared, used and evaluated to improve the quality of care provided to patients suffering with Asthma. The study has discussed the theoretical and practical contributions which increased the novelty in this study. The results of this study are confirmed through the support of social-cognitive theory.
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