Psychosocial Barriers to Asthma Education: Recruitment
A crucial factor for the successful implementation of an education program is the participation of the patient in an enthusiastic manner. We and others have found that patients with uncontrolled asthma may be reluctant to enroll in and complete the educational program. In our own study, it was especially disappointing that those subjects at highest risk, ie, patients with asthma who were hospitalized and those with episodes of near-fatal asthma, were least likely to attend an ambulatory education program. This contrasted with a more homogeneous group, with presumably milder disease treated in a primary care setting who derived significant benefit from such a program. This may well be the biggest psychosocial barrier to the entire asthma education process. Innovative targeting of programs especially in the hospital setting is required.
Recent data from both New York and Chicago indicate that there are significant variations in asthma hospitalization and mortality across neighbourhoods in both these cities. Carr et al identified reports of disproportionately high asthma mortality in New York and further broke these rates down and examined socioeconomic indices, as judged by median income and ethnic groups. Data on hospitalization rates and mortality for 1982 to 1986 and 1982 to 1987, respectively, for patients with asthma aged 0 to 34 years of age, were analyzed. Blacks and Hispanics accounted for 81.8% of all hospitalizations. The greatest increase occurred among persons under age 5 years. Flovent inhaler Link Again this increase was greatest for blacks compared with Hispanics and whites. Similar trends were noted for mortality with more than 76.2% of deaths occurring among blacks and Hispanics. When examined across neighborhoods, hospitalization rates varied by a factor of 16 between the highest and lowest. The highest rate occurred in East Harlem where 93% of the population were black or Hispanic, and the 1979 median income was $11,000. In contrast, the lowest rate occurred in a Manhattan neighborhood that was 70% white and had a median income of $19,000. When the analysis was controlled for income, there remained significant variations, suggesting that poverty does not entirely account for these discrepancies and race and ethnicity also affect these rates. In a similar study examining mortality rates in Chicago, subjects aged 5 to 34 years for the period 1980 to 1988 were reviewed. Like the New York study, mortality rates were disproportionately higher in the city compared with national figures and this increased burden affected mainly blacks. Similar trends were found for socioeconomic status as indicated by median income.