Determinants of quality of life in adults with asthma, and their relevance in intervention development

Abstract

Asthma is a chronic condition requiring long-term management, negatively impacting quality of life (QoL). The present thesis includes three main papers and considers existing literature aiming to explore psychosocial factors which impact QoL in people with asthma and suggest guiding principles to improve QoL in people with severe asthma. Firstly, a systematic review was conducted aiming to identify psychosocial factors impacting QoL in asthma. Findings included psychological factors, health factors and multifactorial aspects, including the interplay of health and psychological factors and asthma. It was noted that outcomes were notably worse for those with poorly controlled asthma (difficult or severe) compared to people with mild or moderate asthma. Secondly, a mixed-methods study was conducted aiming to further understand the relationships between psychological factors and QoL and explore the acceptability of a mindfulness intervention. This included integration of a longitudinal questionnaire and qualitative interviews. Findings showed a dynamic concept of QoL, general positive attitude towards living with asthma and a mindfulness intervention, and the need for relevant asthma-specific interventions. These findings contribute to the development of guiding principles for an intervention to support QoL in asthma. Finally, an interpretative phenomenological study was conducted, aiming to better understand the experience of people living with difficult or severe asthma alongside other physical and psychological conditions. This study found a different experience from that of people with asthma managed in primary care, significant multimorbidity which affected illness perceptions, and QoL described through activity limitation and anxiety. Overall, this thesis proposes guiding principles for future intervention development. These are: consideration of multimorbidity as an important contextual factor for people with asthma, which affects outcomes; QoL is a dynamic concept for people with asthma, not always asthma-specific but often overlapping with activity limitation and anxiety; and finally, there is a need for relevant severe asthma-specific interventions.

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Identifiers

ORCID for Sabina-Claudia Stanescu: orcid.org/0000-0003-0792-8939

ORCID for Sarah Kirby: orcid.org/0000-0003-1759-1356

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

ORCID for Ben Ainsworth: orcid.org/0000-0002-5098-1092

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