Comprehension and Evaluation of a Pictorial Action Plan for Those With Asthma or COPD
Condition: Asthma; COPD
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Some five million people in the United Kingdom (U.K.) have asthma. The British Guidelines on
      Asthma recommend self management education and the issuing of written personal asthma action
      plans. The use of such self management education has been shown to be associated with an up
      to 40% reduction in hospitalisation rates and a 20% reduction in Emergency Department
      attendances and similar benefits in terms of symptoms and time off work. In asthma, the
      results are best when the patients are provided with a personalised written action plan
      explaining how to alter their medications according to a variety of circumstances. Chronic
      obstructive pulmonary disease is a major cause of hospitalisation in the U.K. and is the
      fourth biggest single cause of death. A recent Cochrane review regarding the value of self
      management education in COPD has led to equivocal results although it has shown that those
      with COPD are willing to take control of their own conditions. The reasons for the different
      outcomes in asthma and COPD may reflect an inadequate number of trials of the wrong type;
      interventions that were not appropriate or do not work; lack of the use of written action
      plans; or assessment of benefit using the wrong outcomes.

      Given the importance attached to the written action plan, it is essential that such advice is
      available to all. However, studies of outpatients attending hospitals in the U.K. have shown
      that 15% may be functionally illiterate and in studies of adults with asthma in the United
      States (U.S.), 13% have similarly shown to be functionally illiterate. Pictorial advice may
      therefore be advantageous and, when tested amongst those who are literate, it has been also
      shown to enhance the recall of spoken medical instructions. The investigators have therefore
      prepared some pictorial representations which are designed to give advice to those with
      asthma and COPD about how to recognise the worsening of their conditions and what treatments
      to alter or initiate as a result. The investigators now need to assess the comprehensibility
      of those materials amongst a selection of patients with asthma and COPD.
    

Detailed description: 
      Some five million people in the U.K have asthma. The British Guidelines on Asthma recommend
      self management education and the issuing of written personal asthma action plans. The use of
      such self management education has been shown to be associated with an up to 40% reduction in
      hospitalisation rates and a 20% reduction in Emergency Department attendances and similar
      benefits in terms of symptoms and time off work. In asthma, the results are best when the
      patients are provided with a personalised written action plan explaining how to alter their
      medications according to a variety of circumstances. Chronic obstructive pulmonary disease is
      a major cause of hospitalisation in the U.K. and is the fourth biggest single cause of death.
      A recent Cochrane review regarding the value of self management education in COPD has led to
      equivocal results although it has shown that those with COPD are willing to take control of
      their own conditions. The reasons for different outcomes in asthma and COPD may reflect an
      inadequate number of trials of the wrong type; interventions that were not appropriate or do
      not work; lack of the use of written action plans; or assessment of benefit using the wrong
      outcomes.

      Given the importance attached to the written action plan, it is essential that such advice is
      available to all. However studies of outpatients attending hospitals in the U.K. have shown
      that 15% may be functionally illiterate and in studies of adults with asthma in the U.S., 13%
      have similarly shown to be functionally illiterate. Pictorial advice may therefore be
      advantageous and when tested amongst those who are literate, it has been also shown to
      enhance the recall of spoken medical instructions. The investigators have therefore prepared
      some pictorial representations which are designed to give advice to those with asthma and
      COPD about how to recognise the worsening of their conditions and what treatments to alter or
      initiate as a result. The investigators now need to assess the comprehensibility of those
      materials amongst a selection of patients with asthma and COPD.

      Patients will be recruited from two clinics (asthma and COPD) on a Tuesday morning and
      Thursday afternoon.

      On arrival to the Asthma clinic and to the COPD clinic, patients will be given a short
      information leaflet which they will be invited to read whilst waiting to see the doctor. At
      the end of the routine consultation they will be asked if they would be willing to help with
      the study and will be given a patient information sheet and if the patient agrees he/she,
      will be asked to sign the consent form. The voluntary nature of this and the fact that
      non-participation will not in any way influence their routine care would be stressed
      repetitively, both verbally and of course in the patient information leaflet. If the patients
      were willing to spend a few minutes with the researcher, they would be introduced to the
      researcher by the consultant in clinic and the interview would either occur on that occasion
      or at a pre-arranged time to suit the patient. In the first part of the interview, the
      patient would be given the two pictorial questionnaires to complete which assess the
      translucency and guessability of the pictogram used for the investigators' pictorial action
      plans. The second part of the interview would involve explaining to the patient the concept
      of self management education and personal action plans and a pictorial action plan relevant
      to the patient would be shown to the patient and he/she would be asked to describe what
      action should be taken as a result of the pictorial sequences. A series of short questions
      about the self management plan and his/her preferences for either written or a pictorial plan
      would be asked. The patient would also be asked to undertake the REALM adult literacy test
      and demographic data regarding educational attainment, age and ethnicity would also be
      recorded.
    

Intervention name(s): Pictorial action plan
Intervention type(s): Behavioral
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Pictorial action plan