Abstract
Background Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. Objective To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants’ homes, the point of health care access, or the offices of relevant support organisations. Method In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. Results Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants. Conclusion This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person’s known routines to maximise adherence with preventer medications.
Similar content being viewed by others
References
National Asthma Council Australia. Australian asthma handbook, version 1.0. National Asthma Council Australia, Melbourne, 2014.
Australian Bureau of Statistics (2013c). Australian health survey: health service usage and health related actions, 2011–12. [Internet] 2013 Apr 15. [cited 2015 Mar 20]. Available from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0022011-12?OpenDocument.
Sapra S, Nielsen K, Martin BC. The net cost of asthma to North Carolina Medicaid and the influence of comorbidities that drive asthma costs. J Asthma. 2005;42(6):469–77.
Wen X. Estimates of prevelance of intellectual disability in Australia. J Intellect Dev Disabil. 2004;29:284–9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-V-TR. Washington: American Psychiatric Association; 2013.
Daily DK, Ardinger HH, Holmes GE. Identification and evaluation of mental retardation. Am Fam Physician. 2000;61(4):1059–67.
Harris JC. Intellectual disability: understanding its development, causes, classification, evaluation, and treatment. New York: Oxford University Press; 2006.
Australian Institute of Health and Welfare 2008. Disability in Australia: intellectual disability. AIHW cat. no. AUS 110, AIHW, Canberra.
Sturdy PM, Victor CR, Anderson HR, Bland JM, Butland BK, Harrison BDW, et al. Psychological, social and health behaviour risk factors for deaths certified as asthma: a national case-control study. Thorax. 2002;57:1034–9.
Davis SR, Durvasula S, Merhi D, Young PM, Traini D, Bosnic-Anticevich SZ. Respiratory medication use in an Australian developmental disability clinic population: messages for health care professionals. Aust J Prim Health. 2014;20:278–84.
Huneke NTM, Gupta R, Halder N, Chaudry N. Difficult decisions: are intellectually disabled patients given enough information to consent to medical treatment? J Intellect Disabil. 2012;16(4):265–74.
Turk V, Khattran S, Kerry S, Corney R, Painter K. Reporting of health problems and pain by adults with an intellectual disability and by their carers. J Appl Res Intellect Disabil. 2012;25:155–65.
Arscott K, Stenfert Kroese B, Dagnan D. A study of the knowledge that people with intellectual disabilities have of their prescribed medication. J Appl Res Intellect Disabil. 2000;13:90–9.
Strydom A, Hall I. Randomized trial of psychotropic medication information leaflets for people with intellectual disability. J Intellect Disabil Res. 2001;45(2):146–51.
Creer TL. Behavioral and cognitive processes in the self-management of asthma. J Asthma. 2008;45:81–94.
Smith L, Bosnic-Anticevich S, Mitchell B, Saini B, Krass I, Armour C. Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting. Soc Sci Med. 2007;64:1501–11.
Smith SC, Mitchell C, Bowler S. Patient-centred education: applying learner-centred concepts to asthma education. J Asthma. 2007;44:799–804.
Ziviani J, Lennox N, Allison H, Lyons M, Del Mar C. Meeting in the middle: improving communication in primary health care consultations with people with an intellectual disability. J Intellect Dev Disabil. 2004;29(3):211–25.
DiBlasi A, Kendall S, Spark MJ. Perspectives on the role of the community pharmacist in the provision of health care to people with intellectual disabilities: exploration of the barriers and solutions. Int J Pharm Pract. 2006;14:263–9.
Erikson SR, LeRoy B. Health literacy and medication administration performance by caregivers of adults with developmental disabilities. J Am Pharm Assoc. 2015;55(2):52–60.
Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analyzing qualitative data. London: Routledge; 1994. p. 173–194.
Paasche-Orlow MK, Riekert KA, Bilderback A, Chanmugam A, Hill P, Rand C, et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005;172:980–6.
Finlay WML, Lyons E. Methodological issues in interviewing and using self-report questionnaires with people with mental retardation. Psychol Assess. 2001;13:319–35.
Dodd K. Feeling poorly: report of a pilot study aimed to increase the ability of people with learning disabilities to understand and communicate about physical illness. Br J Learn Disabil. 1999;27:10–5.
Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114:1008–15.
Young AF, Naji S, Kroll T. Support for self-management of cardiovascular disease by people with learning disabilities. Fam Pract. 2012;29:467–75.
van Asselt-Goverts AE, Embregts PJCM, Hendriks AHC. Structural and functional characteristics of the social networks of people with mild intellectual disabilities. Res Dev Disabil. 2013;34:1280–8.
Cheong LH, Armour CL, Bosnic-Anticevich SZ. Patient asthma networks: understanding who is important and why. Health Expect. 2014;. doi:10.1111/hex.12231.
Sibbald B. Patient self care in acute asthma. Thorax. 1989;44:97–101.
Andrews KL, Jones SC, Mullan J. Stigma: still an important issue for adults with asthma. J Asthma Allergy Educ. 2013;4(4):165–71.
Guss D, Barash IA, Castillo EM. Characteristics of spacer device use by patients with asthma and COPD. J Emerg Med. 2008;35(4):357–61.
Australian Medicines Handbook Pty Ltd. Australian Medicines Handbook (online). [Internet]. Adelaide; 2015 [cited 2015 Mar 4]. Available from http://amhonline.amh.net.au/.
Wong JG, Clare ICH, Holland AJ, Watson PC, Gunn M. The capacity of people with a ‘mental disability’ to make a health care decision. Psychol Med. 2000;30:295–306.
Gibson PG, Powell H, Wilson A, Abramson MJ, Haywood P, Bauman A et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2009; (3).
Davis SR. Medication reviews for people with developmental disability—a call to action (letter). J Pharm Pract Res. 2014;44:159–63.
Asthma UK. Easy to read materials. [Internet] 2011 Feb [cited 2015 Mar 16] Available from http://www.asthma.org.uk/Sites/healthcare-professionals/pages/easy-to-read-materials.
Boardman L, Bernal J, Hollins S. Communicating with people with intellectual disabilities: a guide for general psychiatrists. Adv Psychiatr Treat. 2014;20(1):27–36.
Rasartnam R, Crouch K, Regan A. Attitude to medication of parents/primary carers of people with intellectual disability. J Intellect Disabil Res. 2004;48(8):754–63.
Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Scheuch G, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Inhaler Error Steering Committee. Respir Med. 2013;107(1):37–46.
Davis SR, Durvasula S, Merhi D, Young PM, Traini D, Bosnic-Anticevich SZ. The ability of people with intellectual disability to use inhalers–an exploratory mixed methods study. J Asthma. 2015;. doi:10.3109/02770903.2015.1065423.
McDonnell J, McFarland S. A comparison of forward and concurrent chaining strategies in teaching laundromat skills to students with severe handicaps. Res Dev Disabil. 1988;9:177–94.
Primeau MS, Frith KH. Teaching patients with an intellectual disability. Nursing. 2013;43(6):68–9.
Brennan VK, Osman LM, Graham H, Chritchlow A, Everard ML. True device compliance: the need to consider both competence and contrivance. Resp Med. 2005;99(1):97–102.
Melani S, Zanchetta D, Barbato N, Sestini P, Cinti C, Canessa PA, et al. Inhalation technique and variables associated with misuse of conventional metered-dose inhalers and newer dry powder inhalers in experienced adults. Ann Allergy Asthma Immunol. 2004;93(5):439–46.
Australian Bureau of Statistics. Australian Health Survey: Health service usage and health related actions, 2011–2012. Table 7. [Internet] 2013 Apr 15. [cited 2015 Mar 20]. Available from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0022011-12?OpenDocument.
Davis SR, Durvasula S, Merhi D, Young PM, Traini D, Bosnic-Anticevich SZ. The role of direct support professionals in asthma management. J Intellect Dev Disabil. 2015;40(4):342–53. doi:10.3109/13668250.2015.1041100.
Acknowledgments
The authors wish to thank the disability support organisations that assisted with recruitment for this study.
Funding
No specific funding was received for this project.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interests
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Davis, S.R., Durvasula, S., Merhi, D. et al. Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists. Int J Clin Pharm 38, 135–143 (2016). https://doi.org/10.1007/s11096-015-0217-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-015-0217-x