Social Determinants of Health Predicting Asthma Control in Patients with Asthma

Abstract

Introduction Despite the advancements in asthma treatment approaches and medications, the prevalence rate of good asthma control remains low, leading to hospitalizations and emergency visits from exacerbations among patients. The primary goals of asthma control are to reduce emergency visits and hospitalizations due to acute asthma exacerbations and to improve quality of life. The social determinants of health affecting asthma control were the focus of this study, which will lead to more effective short-term and long-term asthma control approaches. 

Objective This study aimed to examine factors including income sufficiency, health literacy, environments at risk of asthma exacerbation, adherence to inhaled corticosteroids, fear of asthma symptoms, and barriers to receiving care in predicting asthma control that predict asthma control in patients with asthma.

Design This study was descriptive research with a cross-sectional design, using the concept of social determinants of health as the conceptual framework, explaining that a person’s disease control is not merely influenced by individual, genetic, physiological, or behavioral factors. It may also be caused by social and environmental factors in which a person lives. These factors may contribute to differences in health determinants among individuals, ultimately influencing health outcomes and health equity.

Methodology The sample consisted of 130 asthma patients who attended follow-up appointments at the outpatient department of a tertiary hospital in Bangkok from February to April 2024. The sample size was determined using power analysis principles with the G*Power software for logistic regression analysis. The significance level was set at an alpha (α) of .05, the power of test at .80, and an odds ratio of 3.64, based on previous research studying adherence to inhaled corticosteroids and clinical control outcomes in asthma patients. Through purposive sampling, the inclusion criteria were 1) aged 20 years and older and 2) diagnosed with asthma and used inhaled corticosteroids for at least 3 months. Instruments included a personal information and medical history questionnaire, the Hill-Bone Medication Adherence Scale (HB-MAS), the Environment at Risks of Asthma Exacerbation Questionnaire, the Barriers to Receiving Care Questionnaire, the Fear of Asthma Symptoms Scale (FAS), the short version of the European Health Literacy Survey (HLS-EU-Q16), and the Asthma Control Questionnaire based on the GINA guideline 2023. The quality of the instruments was evaluated by determining their reliability. The Cronbach’s alpha coefficients were used for assessing the reliability of the research instruments as follows: the HB-MAS, the Environment at Risks of Asthma Exacerbation Questionnaire, the Barriers to Receiving Care Questionnaire, and the FAS were equal to .83, .71, .75, and .87, respectively. Additionally, the Kuder-Richardson-20 was used to assess the reliability of the HLS-EU-Q16 and the Asthma Control Questionnaire, obtaining values of .87 and .83, respectively. Data were collected using self-administration and were analyzed using descriptive statistics and logistic regression.

Results More than half of the sample was aged 60 – 79 years (56.10%) and female (66.90%). Less than half of the sample (39.20%) had a monthly income of less than 10,000 baht, while 43.10% had insufficient income. The factors correlated with asthma control were found to be environments at risk of asthma exacerbation (c2 = 20.615, p < .001), adherence to inhaled corticosteroids (c2 = 16.830, p < .001), fear of asthma symptoms (c2 = 14.282, p < .001), and barriers to receiving care (c2 = 13.593, p < .001). Environments at risk of asthma exacerbation and adherence to inhaled corticosteroid use were able to predict asthma control with statistical significance (OR = 7.08, 95%CI = 2.27, 22.08, p < .001 and OR = 13.15, 95%CI = 2.21, 78.18, p = .005, respectively).

Recommendation According to the findings in this study, nurses should prioritize the assessment of environmental factors and patient adherence to inhaled corticosteroid use. This approach enables asthma patients to avoid risky environments and promotes adherence to inhaled corticosteroid use.