Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

J Asthma. 2018 Aug;55(8):924-932. doi: 10.1080/02770903.2017.1373393. Epub 2017 Oct 20.

Abstract

Objective: To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control.

Methods: Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors.

Results: Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss.

Conclusion: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.

Keywords: Asthma disparities; community-based participatory research; community-engaged research; legal advocacy; medical-legal partnerships; social determinants of health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allergens / adverse effects
  • Asthma / diagnosis
  • Asthma / etiology
  • Asthma / prevention & control
  • Asthma / therapy*
  • Community Health Centers / organization & administration
  • Community Participation
  • Connecticut
  • Environmental Exposure / adverse effects*
  • Female
  • Health Status Disparities*
  • Housing*
  • Humans
  • Male
  • Middle Aged
  • Patient Advocacy*
  • Qualitative Research
  • Risk Factors
  • Socioeconomic Factors
  • Surveys and Questionnaires / statistics & numerical data
  • Urban Population

Substances

  • Allergens