Exploring the Socio-environmental context in the Prevalence and Management of Asthma at Scottish General Practices

摘要

Thesis Title: Exploring the Socio-environmental Context in the Prevalence and Management of Asthma at Scottish General Practices.Worldwide, asthma is a chronic condition which is prevalent and neglected and Scotland has a high prevalence of asthma compared to the rest of the world. In their report on the global burden of asthma, the Global Initiative for Asthma (GINA) Program ranks Scotland as having the highest asthma prevalence in the world, with almost one in every five people affected and 6.3 % of the population in Scotland are seeking treatment at General Practices. The aetiology of asthma is complex and it remains a persistent and chronic problem affecting many people, and prevention and treatment are not working. This thesis makes a unique contribution utlising an interdisciplinary approach from Geography and Public Health to explore the nature and role of the socio-environmental context in relation to the prevalence and management of asthma at Scottish General Practices located in areas of dissimilar deprivation levels. The key focus of the research is the way that health professionals (and related stakeholders) understand the factors that shape the causation and prevalence of asthma (including social and environmental contexts), and how this in turn shapes their management of the condition in their practice.Aim: The overall aim of this research is identify, understand and interpret the nature and role of the socio-environmental context in relation to asthma prevalence and management at the Scottish primary care setting.Methods: The research employed quantitative analysis of a secondary dataset on asthma and a case study analysis of two General Practices located in areas of dissimilar deprivation levels in Scotland. Practices were selected after quantitative data analysis comparing the deprivation scores (SIMD) against crude prevalence rates of asthma. The case study employed in-depth semi-structured interviews with stakeholders involved in asthma care.The results of the study contributed to the understanding of what a conventional deprivation measure does/ does not reveal about asthma–place contexts. It also gave insights on how health professionals perceived their area, patient population and how they integrated these perceptions it into their practice as their understanding or lack of understanding or their inability to act upon their understanding on the importance of the socio-environmental context was one of key factors that shape their management of asthma. The study concluded imparting policy implications and renewed approaches to asthma care and management practices within the Health Services.