DIFFERENTIAL INFLUENCES ON ASTHMA SELF-MANAGEMENT KNOWLEDGE AND SELF-MANAGEMENT BEHAVIOR IN ACUTE SEVERE ASTHMA

Aim: While asthma education increases knowledge, it is less clear whet her education influences actual patient behavior. To determine whether there are differences between asthma self-management knowledge and th e actual behavior of patients during an acute severe asthma attack and to determine which clinical and psychosocial factors are associated w ith knowledge and behavior. Methods: Validated hypothetical scenarios describing the development of life-threatening asthma and patients' re ported actual behavior were scored (out of 25) using a system based on Thoracic Society of Australia and New Zealand and British Thoracic So ciety criteria. Results: In 137 patients admitted to the hospital with severe asthma, the pattern of the index attack was slow onset (greate r than or equal to 6 h) in 96%. The score for the hypothetical attack (knowledge) was 13.8 +/- 4.6, while that for the timeline (behavior) w as 10.2 +/- 3.9 (p < 0.001) with 56% and 84%, respectively, having a s core of less than 15 (regarded as inadequate). Certain components show ed marked discrepancy leg, appropriately seeking medical help 82% vs 5 2% (p < 0.001) and calling ambulance 61% vs 23% (p < 0.001). Factors s uch as physician-patient relationship, previous asthma morbidity, avai lability of peak flowmeter, action plan, and oral steroids correlated positively with both measures. Knowledge was negatively associated wit h being non-European, with anxiety, pessimism, and stigmatization. Beh avior (but not knowledge) was negatively associated with lack of knowl edge of what to do in the index attack, previous emotional counseling, and business failure. Those factors associated with the difference be tween knowledge and behavior scores (knowledge-behavior gap) were bein g non-European, anxiety, pessimism, and stigmatization, concerns about medical costs, and the only income for the household being a Social S ecurity benefit. Conclusion: There are marked differences between pati ents' self-management knowledge and their actual behavior, particularl y in terms of potentially life-saving actions. Psychological, health-c are, and socioeconomic factors have a powerful and differential influe nce on knowledge and behavior. Improved understanding of the discrepan cies between knowledge and behavior and which factors influence them m ay lead to more effective asthma educational interventions.