The Science Journal of the American Association for Respiratory Care
BACKGROUND: Clinical observations suggest that the beliefs, feelings and attitudes of patients with asthma may affect asthma care and the doctor-patient relationship and hence the degree to which their health is ?at risk?. We have developed a questionnaire - the Asthma NavigatorTM - designed to (i) identify patients beliefs, feelings and attitudes related to their asthma and (ii) classify them into clinically meaningful streams according to their responses. METHOD: Using a ?grounded theory? approach, 70 adults with asthma were interviewed to ascertain beliefs, attitudes and behaviours (?dimensions?) related to asthma and its management, information and arguments that supported those beliefs, and factors that influenced changes. Analysis identified four patient ?streams?: Stream 1 - individuals who self-treat, rarely visit health professionals, and may lack knowledge of asthma treatment; Stream 2 - individuals whose views threaten adherence with accepted asthma management and put them at risk; Stream 3 - those with ?suboptimal? characteristics, between streams 2 and 4, and with evidence of potential for transition; and Stream 4 - individuals coping maturely and in control of their asthma. A pilot questionnaire to allow for clinical determination of Stream was then developed and, after review by an expert panel and field testing, administered to more than 360 patients with asthma in three Australian cities.
Results: Statistical and technical analyses of questionnaire responses confirmed the four streams and allowed consolidation to 96 items assessing 10 relevant dimensions. Factor analysis identified three underlying ?factor-dimensions? dealing with (i) asthma awareness, acceptance and management; (ii) beliefs and knowledge about medication; and (iii) feelings and perceptions about the doctor-patient relationship. Reliability (alpha) coefficients for streams, dimensions and factor-dimensions ranged from 0.62 to 0.94 (mean 0.73), and split-half coefficients from 0.65 to 0.94 (mean 0.73), consistent with figures obtained for well-established questionnaires of personal characteristics. Re-testing of a random sample (n = 184) after 9 months indicated 95% persistence of initial stream classification.
Conclusions: The Asthma Navigator is a robust and valid source of information on persistent beliefs, attitudes and behaviours that may be relevant to doctor-patient partnering relationships and ultimately to health outcomes for people with asthma.