The experience of adult Omani women living with asthma : an exploratory study

____________________________________________________________ 12 Declaration __________________________________________________________ 13 Copyright Statement ___________________________________________________ 13 Dedication ___________________________________________________________ 14 Acknowledgements ____________________________________________________ 14 The Author __________________________________________________________ 15 List of Abbreviations __________________________________________________ 17 Thesis Structure ______________________________________________________ 18 CHAPTER ONE: STUDY BACKGROUND ______________________________ 20 Introduction ____________________________________________________ 20 1.1 Chronic illness __________________________________________________ 20 1.2 Transition of the global burden of chronic conditions ____________________ 20 1.3 Prevalence of chronic illness _______________________________________ 21 1.4 Meaning of chronic illness _________________________________________ 22 1.5 Experience of chronic illness _______________________________________ 23 1.6 1.6. 1 Theories about health behaviours and the Health Belief Model _________ 24 1.6. 2 Self-efficacy _________________________________________________ 25 1.6. 3 Self-Regulation Model _________________________________________ 26 1.6. 4 Illness trajectory ______________________________________________ 28 1.6. 5 Biographical disruption ________________________________________ 30 1.6. 6 Uncertainty __________________________________________________ 31 1.6. 7 Stigma _____________________________________________________ 32 Asthma: a worldwide problem ______________________________________ 34 1.7 1.7. 1 Burden of asthma _____________________________________________ 35 1.7. 2 Development of asthma management _____________________________ 36 Asthma within the research context __________________________________ 38 1.8 Women’s health _________________________________________________ 39 1.9 3 1.9. 1 Women’s experience of chronic disease ___________________________ 40 Description of the study context: the Sultanate of Oman _________________ 41 1.10 1.10. 1 Geographic description ________________________________________ 41 1.10. 2 Omani population and demographic transition _____________________ 43 1.10. 3 Healthcare services in Oman ___________________________________ 46 1.10. 4 Oman: the health transition towards chronic illness __________________ 47 1.10. 5 Prevalence of adult asthma in Oman _____________________________ 48 1.10. 6 Asthma research in Oman______________________________________ 49 1.10. 7 Women in Oman _____________________________________________ 49 Summary _____________________________________________________ 51 1.11 CHAPTER TWO: LITERATURE REVIEW _____________________________ 54 Introduction ____________________________________________________ 54 2.1 Literature review as part of grounded theory research ____________________ 54 2.2 Narrative review _________________________________________________ 55 2.3 Aim of the literature review ________________________________________ 57 2.4 Review questions ________________________________________________ 57 2.5 Search strategy __________________________________________________ 57 2.6 Assessment of the quality of the selected studies ________________________ 59 2.7 Findings of the search _____________________________________________ 60 2.8 Description of the synthesised studies ________________________________ 63 2.9 Synthesis of the review findings ___________________________________ 63 2.10 2.10. 1 Effect of asthma on people’s lives _______________________________ 63 2.10. 2 Living with asthma day to day __________________________________ 68 2.10. 3 Experience of patients with asthma, medical treatment and factors influencing their practice ______________________________________ 70 2.10. 4 Experience of asthma services __________________________________ 75 2.10. 5 Attitude towards self-management _______________________________ 80 Quality of the studies included _____________________________________ 83 2.11 2.11.1 Qualitative studies ___________________________________________ 84 2.11.2 Mixed methods ______________________________________________ 87 Overall weight of evidence ________________________________________ 89 2.12 Research gap identified __________________________________________ 90 2.13 2.14 Summary _____________________________________________________ 90 CHAPTER THREE: RESEARCH METHODOLOGY AND METHODS _____________________________________________________ 95 4 Introduction ____________________________________________________ 95 3.1 Research aim ___________________________________________________ 95 3.2 Research questions _______________________________________________ 95 3.3 Qualitative approach _____________________________________________ 95 3.4 Underpinning assumptions _________________________________________ 96 3.5 Theoretical perspective: symbolic interactionism _______________________ 97 3.6 Social constructionism ____________________________________________ 99 3.7 Methodology of grounded theory __________________________________ 100 3.8 3.8. 1 Three versions of grounded theory ______________________________ 101 Selecting constructivist grounded theory _____________________________ 103 3.9 Gaining access to the research settings and recruitment ________________ 104 3.10 Sampling ____________________________________________________ 105 3.11 3.11.1 Purposive sampling _________________________________________ 107 3.11.2 Theoretical sampling ________________________________________ 108 Data generation _______________________________________________ 110 3.12 3.12.1 Intensive interviews _________________________________________ 110 3.12.2 Interview topic guide ________________________________________ 111 3.12.3 Collecting data _____________________________________________ 112 Transcribing __________________________________________________ 114 3.13 Translating ___________________________________________________ 115 3.14 3.15 Data management ______________________________________________ 117 Data analysis _________________________________________________ 118 3.16 3.16. 1 Coding ___________________________________________________ 118 3.16. 2 Constant comparative method _________________________________ 120 3.16. 3 Memo writing ______________________________________________ 121 Theoretical saturation ___________________________________________ 122 3.17 Theoretical sensitivity __________________________________________ 122 3.18 Ethical considerations and research governance ______________________ 124 3.19 3.19. 1 Informed consent ___________________________________________ 124 3.19. 2 Confidentiality and anonymity _________________________________ 125 3.19. 3 Autonomy _________________________________________________ 126 3.19. 4 Maintaining the dignity of and respect for the participants ___________ 127 Rigour of the research __________________________________________ 128 3.20 3.20. 1 Credibility ________________________________________________ 128