Family Practice Vol. 19, No. 3, 290-293
© Oxford University Press 2002
Experiences by patients with asthma-like symptoms of a problem-based learning health education programme
a Department of Health and Environment, Division for Preventive and Social Medicine, University of Linköping, Linköping,
b Nordic School of Public Health, Göteborg,
c Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Göteborg,
d School of Health Sciences, Borås and
e The Queen Silvia's Children Hospital, Sweden.
KC Ringsberg, Nordic School of Public Health, Box 12133, SE-402 42 Göteborg, Sweden.
Ringsberg KC, Lepp M and Finnström B. Experiences by patients with asthma-like symptoms of a problem-based learning health education programme. Family Practice 2002; 19: 290–293.
Received 18 December 2000; Revised 6 September 2001; Accepted 7 January 2002.
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Abstract |
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Background. Eighteen patients with asthma-like symptoms but negative asthma tests, randomly selected, participated in a problem-based learning health education programme. The programme had a multidisciplinary approach and included exercises inspired by cognitive behavioural therapy.
Objective. The aim of this study was to describe how the patients experienced the programme.
Methods. After termination of the programme, semi-structured interviews with a phenomenographic approach were conducted with 15 of the participants.
Results. Two categories emerged, with three sub-categories each. In these, the informants described how they felt solidarity with the group, received confirmation from the other participants and had increased their self-confidence. They had started to look upon themselves and the disorder from a different perspective, they could describe the disorder in words and they had started to use new, conscious coping strategies.
Conclusions. Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.
Keywords. Asthma, asthma-like symptoms, multidisciplinary rehabilitation, phenomenography, problem-based learning health education.
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Introduction |
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Patients suffering from asthma-like symptoms but with negative asthma tests have few strategies to cope with their symptoms and life situation; the disorder incapacitates them physically, psychologically and socially.1–3 The usual medical treatment for asthmatics is ineffective. A health education programme was used for their rehabilitation.4 The programme had a multidisciplinary approach, was conducted according to the problem-based learning (PBL) model for health education and included specific exercises inspired by cognitive behavioural therapy.
The aim of the present study was to describe how a PBL health education programme was experienced by patients with asthma-like symptoms but negative asthma tests.
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Methods |
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Selection of informants
The participants had negative asthma tests, i.e. (i) lack of reversibility defined as an increase of forced expiratory volume in 1 second (FEV1) or peak expiratory flow rate (PEFR) values after inhalation of a ß2-stimulant <10%; (ii) normal FEV1 or PEFR values before inhalation of a ß2-stimulant defined as
90% of predicted normal; (iii) a negative methacholine test defined as PC20 8 mg/ml; (iv) variability of the PEFR values of <20%; and (v) negative skin prick testing. They were not to have any other diagnosed disease that could have any impact on their respiratory function. Smokers were excluded. To preclude a precursory stage to asthma, they should have suffered from the disorder for at least 2 years.
Thirty-eight patients with asthma-like symptoms consecutively drawn from an out-patient clinic for asthma and allergy were allocated randomly to two groups: an intervention group (n = 18) and a control group (n = 20). Both groups answered structured questionnaires.4 The intervention group participated in the health education programme. The group was divided into three subgroups who met for 2 hours on seven occasions, every second week. Fifteen patients attended all sessions, three patients five. Two months after the health education programme was finished, the patients from the intervention group were asked to describe their experiences of it. Three refused due to lack of time. This probably did not bias the selection of informants (Table 1
). The study was approved by the Research Ethics Committee, Göteborg University.
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Data collection and analysis
In collecting and analysing data, the qualitative phenomenographic method was used.5,6 The interviews, open and semi-structured, were tape-recorded and typewritten verbatim. The guiding question for the interviews was of a comprehensive character: "What has been achieved by participating in the programme?" One person carried out the interviews, another the analyses. None of them was involved in the health education programme. A co-examiner was assigned to test the credibility of the categories and sub-categories. As for qualitative studies in general, one must be cautious with generalizations.
The PBL health education programme
The disorder and the life situation of the participants were discussed from different perspectives. The teachers were qualified in the fields of pulmonary medicine, allergology, social medicine, physiotherapy, psychology and pedagogy.
The health education programme was based on the PBL pedagogical model.7,8 The teachers supported each participant in a dialogue with the others to stimulate them to learn as much as possible, and facilitated the group process. The participants were considered to be experts on their disorder, since they had experienced living with asthma-like symptoms.
One goal for the participants was to identify factors that trigger their breathing problems according to three topics based on earlier research3:
- to reflect upon cognitive structures and different modes of thinking;
- to be subjectively hyperreactive; and
- to be socially limited.
Another goal for the participants was to find problem- and emotion-focused strategies to cope with their symptoms and disorder. The participants started to work with the topics in the subgroup, continued individually between the group sessions, and then had a final discussion in the subgroup. Within each topic, they worked according to the five steps described in PBL.7,8
This kind of patient easily gets stuck in a dysfunctional way of thinking.3 To encourage the participants to find new patterns of reasoning, thinking and coping with their perceptions, exercises inspired by cognitive behavioural therapy were used.9 They were asked to record in ‘schemes’ daily events that triggered their symptoms, their feelings, their automatic thoughts when they occurred, rational alternative thoughts and the result of their own analysis.9 The schemes were discussed from different perspectives with the other participants and the teachers during the group sessions.
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Results |
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Two categories emerged, consisting of three subcategories each, that describe the informants' various conceptions of their participation in the programme (Fig. 1
).
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The first category, ‘The group as a forum’, contains conceptions that emphasize the strength and importance of the group process for the individual person's development. The category is comprised of three sub-categories. In the first, the feeling of solidarity with the group members is emphasized. The second sub-category stresses the content of receiving and giving confirmation. In the last category, expressions of increased self-confidence are emphasized. Meeting people with similar problems and experiences made the informants feel relieved and more normal, realizing that they were not alone in having asthma-like symptoms. They had a feeling of solidarity with the other group members. By sharing feelings, they received confirmation from each other. Their self-confidence was hereby strengthened, which in turn led them to dare to practise new things and to have faith in themselves.
In the second category, ‘Reflection on oneself and coping with the disorder’, conceptions are described that emphasize reflection upon their own and others' reactions. The category is made clear by three sub-categories. In the first sub-category, the meaning of looking at oneself and opening one's mind to new perspectives is stressed. The second sub-category emphasizes the ability to describe the disorder in words. The third sub-category contains reflections about using new conscious strategies to cope with the disorder. During the programme, the participants started to look at the disorder from various perspectives, which gave them a new approach. They acquired verbal knowledge to describe the existing disorder, and gained new, conscious coping strategies. The whole process strengthened their self-confidence so that they could use their new coping strategies in relation to the disorder and in different situations.
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Discussion |
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It has been shown previously that the patients, by participating in the health education programme, decreased the frequency of symptoms.4 The present study shows that they also conceived that they increased their self-confidence, reflected upon themselves and the disorder and used new strategies to cope with it. The programme emanated from the participants' own life-world and personal experiences. They were thereby emotionally involved and thus more motivated to seek a deeper understanding of their disorder. This in turn influenced them to be more likely to adopt new coping strategies. By using PBL, an active participation was demanded of the participants. This gave them an opportunity to influence and take more responsibility for their own rehabilitation.
It is most likely that the concept of the health education programme described in this study can be used as a complement to traditional treatment for other kinds of patients with multiple or diffuse symptoms. When treating such patients, it is important not only to focus on the symptoms from a medical perspective but also to have a broad multidisciplinary approach to elucidate the patient's overall situation and living conditions. The aim of multidisciplinary rehabilitation programmes often is to reduce passive sick-role behaviour and to encourage the patients to take more responsibility for their lives,10 as the informants of this study clearly expressed.
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Acknowledgments |
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The authors are grateful to Professor Olle Löwhagen, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg University, Sweden, for kindly placing the patients at our disposal, to Paula Bjärneman, RN and Katarina Pettersson, RN for participating as teachers in the programme, and Lotta Dellve, RN MScPH for conducting the interviews. This study was supported by grants from the Swedish Foundation for Health Care and Allergy Research.
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Notes |
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An extended version of this article with quotations from the informants can be obtained from the authors.
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References |
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1 Ringsberg KC, Löwhagen O, Sivik T. Psychological differences between asthmatics and patients suffering from an asthma-like condition, functional breathing disorder: a comparison between the two groups concerning personality, psychosocial and somatic parameters. Integr Physiol Behav Sci 1993; 28: 358–367.[Web of Science][Medline]
2 Ringsberg KC, Segesten K, Åkerlind I. Walking around in circles—the life situation of patients with asthma-like symptoms but negative asthma tests. Scand J Caring Sci 1997; 11: 103–112.[Web of Science][Medline]
3 Ringsberg KC, Åkerlind I. Presence of hyperventilation in patients with asthma-like symptoms but negative asthma tests. Provocation with voluntary hyperventilation and mental stress. J Allergy Clin Immunol 1999; 103: 601–608.[Web of Science][Medline]
4 Ringsberg KC, Timpka T. Clinical health education for patients with asthma-like symptoms but negative asthma tests. Allergy 2001; 56: 1049–1054.[Web of Science][Medline]
5 Marton F. Phenomenography—a research approach to investigating different understandings of reality. J Thought 1986; 21: 28–49.
6 Svensson L. Theoretical foundations of phenomenography. Higher Educ Res Dev 1997; 16: 159–171.
7 Boud D, Feletti G (eds). The Challenge of Problem Based Learning, 2nd edn. London: Kogan Page, 1997.
8 Norman G, Schmidt H. The psychological basis of problem-based learning: a review of the evidence. Acad Med 1992; 67: 557–565.[Web of Science][Medline]
9 Beck JS. Cognitive Therapy. Basics and Beyond. New York: The Guilford Press, 1995.
10 Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers; a meta-analytic review. Pain 1992; 49: 221–230.[Web of Science][Medline]
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