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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 118-122

Impact of pharmacist education on knowledge, attitude, and practice of patients using inhaler medications in obstructive airway diseases


1 Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, NITTE (Deemed to be University), Mangaluru, Karnataka, India
2 Department of Pulmonary Medicine, K. S. Hegde Medical Academy, Justice K. S. Hegde Charitable Hospital, NITTE (Deemed to be University), Mangaluru, Karnataka, India

Date of Submission18-Dec-2019
Date of Decision22-Dec-2019
Date of Acceptance10-Jan-2020
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Uday Venkat Mateti
Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Paneer, Deralakatte, Mangaluru - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_224_19

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  Abstract 


Objective: Inappropriate use of inhaler medications may lead to inadequate control of the disease condition. Therefore, it is important to educate the patients regarding proper inhalation technique. The objective of the study is to assess the knowledge, attitude, and practice (KAP) of patients using inhaler medications in obstructive airway diseases before and after education. Materials and Methods: A quasi-experimental pre- and post-study without a control group was conducted among sixty patients diagnosed with obstructive airway diseases who were using inhaled medications in the pulmonary medicine department. At the baseline, the patient's KAP was assessed and were educated regarding the use of inhaler medications. Then, the patient's KAP was again assessed after 1 month of baseline assessment. Results: Of sixty patients, male patients (53%) were predominant than the female (42%). The mean age of the study population was 56.7 ± 16.2 years. The pre- and post-educational KAP scores of the patients were 71.6 ± 9.9 and 82.9 ± 10.3, respectively. The KAP scores were statistically improved, and the mean change in the KAP score was 11.3 ± 6.9 (P = 0.000). Conclusion: The education provided in the small group of patients using inhaler medications leads to the betterment of KAP of the patients.

Keywords: Attitude, inhaler medications, knowledge, obstructive airway diseases, practice


How to cite this article:
John JA, Mateti UV, Rajesh V. Impact of pharmacist education on knowledge, attitude, and practice of patients using inhaler medications in obstructive airway diseases. J Datta Meghe Inst Med Sci Univ 2020;15:118-22

How to cite this URL:
John JA, Mateti UV, Rajesh V. Impact of pharmacist education on knowledge, attitude, and practice of patients using inhaler medications in obstructive airway diseases. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 23];15:118-22. Available from: http://www.journaldmims.com/text.asp?2020/15/1/118/297983




  Introduction Top


An obstructive lung disease is a group of respiratory diseases which is marked by an obstruction in the large and small airway. It mainly includes disorders of the airways such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and bronchiolitis.[1] Inhaler medications are the most commonly used route for treating obstructive airway diseases. Inhaler medications are the medicines that are delivered directly into the lungs. There are a variety of devices that deliver the medicine directly into the lungs, and these medications include metered dose inhalers (MDIs), dry powder inhalers (DPIs), nebulizers, and soft mist inhalers.[1]

The majority of the patients (80%–90%) receive the benefit if the inhaler medications are taken regularly and in a proper manner. If the inhaler technique is incorrect, the drug delivery to the airways will be less than expected.[2] Inappropriate technique and noncompliance to medications can cause adverse effects, exacerbation of disease condition leading to hospitalization, and increased health-care costs.[3],[4] Therefore, it is important to educate the patient regarding the proper use of inhaler medications. Studies have shown that patient counseling and education regarding the disease and medications can improve the knowledge, attitude, and practice (KAP) of the patients.[5],[6],[7]

Study objective

The present study aims to evaluate the impact of education on the patient's KAP score in the use of inhaler medications and thereby contribute to improving the control of disease through education and sharing information to enable these patients to live an active and productive life.


  Materials and Methods Top


Study design and setting

Quasi-experimental pre- and post-study without a control group was conducted in the Pulmonary Medicine Department, Charitable Hospital, Mangaluru for 8 months (September 2017–April 2018).

Study criteria and sample size

Patients age >18 years who are diagnosed with obstructive airway diseases and using inhaler medication for 1 month were included in the study. Patients with any psychiatric problems and not willing to provide written consent were excluded from the study. The sample size was calculated based on the similar studies and availability of patients in the setting.[8],[9] The minimum sample required for the study was sixty.

Development of knowledge, attitude and practice questionnaire and patient information leaflet

The KAP questionnaire and patient information leaflet (PIL) was developed by referring primary (10), secondary (20), and tertiary (30) resources. 10 resources included various articles related to the use of inhalers.[10],[11],[12],[13] 20 resources included various databases such as Medscape, WebMD and UpToDate.[14],[15],[16] 30 resources included textbooks like pharmacotherapy,[17] and community pharmacy practice.[18] The content of the PIL included the information on usage instructions, do's and don'ts, storage and special precautions on inhaler medications such as MDIs, MDIs with spacer and rotahalers and rotacaps. A total of 16 KAP questions were prepared covering the domains of knowledge (n = 5), attitude (n = 5), and practice (n = 6) in the use of inhaler medications.

Validation and translation of knowledge, attitude and practice questionnaire and patient information leaflet

The KAP questionnaire and PIL were validated by an expert team of pulmonologists (n = 2) and academic pharmacists (n = 3). The validation was completed using criteria checklist for the assessment of the tool. The experts were asked for the necessary suggestions in the model submitted to them. Necessary changes were made in the questionnaire and PIL as per the expert guidance. The validated KAP questionnaire and PIL were translated into Kannada and Malayalam (local languages) using three step method of “forward translation, backward translation, and patient testing.”[19]

Readability and design of patient information leaflet

The Flesch reading ease (FRE) and Flesh-Kincaid grade FKG) level readability tests scores were calculated using the Microsoft Office Word 2007.

The layout and design of the leaflet were done as per the Baker Able Leaflet Design (BALD) criteria, which includes the length of, separation between lines, unjustification of lines, serif typeface, type size, etc.[20]

Reliability of knowledge, attitude and practice questionnaire

The reliability of the KAP questionnaire was assessed using Cronbach's alpha. Reliability was checked in 12 randomly selected patients by applying Kuder and Richardson formula 20,[21] as follows:



Data collection and patient education

Patients who met the study criteria and provided written informed consent were assessed for KAP of the use of inhaler medications. The details such as age, gender, educational background, social habits, type of inhalers, disease condition, and comorbidities were collected from patient's medical records. The patients were educated on the use of inhaler medications by using the validated PILs after the baseline KAP assessment.

Assessment of outcomes

The impact of patient education was assessed after 1 month of the baseline KAP. The patients were given a reminder call regarding the revisit. The patient's KAP was calculated based on the following formula:

KAP score = (Total number of correct answers/Total number of actual answers) ×100

Statistical analysis

Descriptive statistics such as mean and standard deviation of KAP scores, were used to summarize the data. Comparison between the scores of pre- and post-education was analyzed using paired t-test. The correlation of age and change in KAP was analyzed using Pearson correlation. Assessment of change in KAP was analyzed using the ANOVA test. The P < 0.05 was considered to be statistically significant. The data were analyzed using SPSS software version 20.0 (Chicago, Illinois, USA).

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of JNMC, Sawangi (Meghe), Wardha, on 2nd Sept 2019. With ethical clearance no NITTE(DU)/EC/2019-20/94.


  Results Top


Readability and Baker Able Leaflet Design scores of patient information leaflet

The FRE and FKG test readability scores were 64 and 7.3, respectively. The BALD scores for English, Kannada, and Malayalam version of leaflets were 27, 26, and 25, respectively.

Reliability of knowledge, attitude, and practice questionnaire

The Cronbach's alpha reliability of the KAP questionnaire was 0.752.

Demographic data of patients

A total number of sixty patients were included in the study based on the inclusion and exclusion criteria. Of sixty patients, seven patients did not come for follow-up and one patient expired in the study period. At the end of the study, 52 patients completed the educational session. Of sixty patients, most of them were in the age group of 50–59 years (26.7%), followed by 23.3% in the age group of 60–69 years. The mean age of the study population was found to be 56.7 ± 16.2 years. Majority of the patients were male (58.3%). Majority of the patients (51.7%) in the study had primary education followed by secondary education (33.3%), graduates (8.3%), and 6.7% were illiterate. Most of the patients (63.3%) have been using DPIs, followed by 28.3% of the patients using MDIs and 8.3% of the patients using MDIs with spacer. The demographic data of the patients are summarized in [Table 1].
Table 1: Demographic details of patients

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Assessment of knowledge, attitude, and practice before and after education

It was found that the overall KAP has increased from baseline to posteducation. The mean change in KAP, and overall KAP in the study population from the baseline to posteducation scores was 9.9 ± 13, 9.2 ± 10.8, 14.9 ± 11.9, and 11.3 ± 6.9, respectively. The detailed KAP score of the patient's results are shown in [Table 2].
Table 2: Knowledge, attitude, and practice scores of the patients before and after education

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Association of patient's knowledge, attitude, and practice with gender and education level

The study results show that the patient's gender and level of education do not have any significance (P > 0.05) with the change in KAP scores. The association of patient's KAP scores with gender and education is summarized in [Table 3].
Table 3: Association of change in knowledge, attitude, and practice scores with respect to gender and level of education

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Correlation of age with knowledge, attitude, and practice scores of patients

The Pearson correlation shows that age has a negative correlation with that of change in KAP scores, i.e., as age increases, the KAP scores decreased. It also shows that age has significance with the change in knowledge (P = 0.007) and change in KAP (P = 0.007). The correlation of age with KAP of the patient is summarized in [Table 4].
Table 4: Correlation of age with knowledge, attitude, and practice scores of patients

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  Discussion Top


The FRE and FKG readability test scores of PIL were as 64 and 7.3. The readability scores were found in the Sekhar et al., (73.9 and 6.1) and Roy et al., (69.9 and 7.1).[8],[22] The BALD scores of the PILs were found to be as 27, 26, and 25 for English, Kannada, and Malayalam version, respectively. The study findings of Sekhar et al., and Mateti et al. showed similar results where the BALD scores were 27 and 28 for the English version and 26 for the Kannada version.[8],[9]

The mean age of the study population was 56.7 ± 16.25 years. These findings were in contrast with a similar study conducted by Al Ammari et al., and Rajanandh et al., where the mean age was 58.4 ± 17.9 and 38.37 ± 14.87 years.[23],[24] It was observed in the study that male patients (58%) outnumbered female patients (42%). Similar findings were observed in the studies conducted by Shyam et al., and Rajanandh et al.[24],[25]

Majority of the patients in the study had COPD (45%). This results were contradictory to the study conducted by Al Ammari et al., where a majority of the patients were having bronchial asthma (61.7%) and Hämmerlein et al., results showed that majority were asthma patients (50.2%).[23],[26]

In the present study, most of the patients were using DPIs (63.3%), followed by MDIs (28.3%) and MDIs with spacer (8.3%). These results were in contrast with the study conducted by Hämmerlein et al., where a majority of the patients were using DPIs (63.3%) followed by MDIs (29.7%) and MDIs with spacer (2.5%).[26]

The most common comorbidity that was found in this study was hypertension (34.2%), diabetes (31.4%). The study conducted by Al Ammari et al. reported that the most common comorbidity found in the study population was diabetes (46.8%), followed by cardiovascular diseases (31.9%).[23]

Most of the patients in the study had fair KAP on the use of inhaler medications at the baseline. Comparable results were observed in the earlier studies, which revealed that 77.5%–89.2% of patients use an inappropriate inhalation technique.[27],[28]

The KAP has increased after the education from baseline (71.6) to posteducation (82.9) with P = 0.000. Similar findings were observed in studies conducted by Purohit et al., (26.42–49.06), Rajanandh et al., (38–94.2), and Shyam et al., (31.61–63.77).[24],[25],[29] In our study, the improvement in KAP was seen after 1 month of baseline education, but the study conducted by Purohit et al., showed that the better use of inhalation technique was improved with 15 days of education.[29]


  Conclusion Top


The pre- and post-educational KAP scores of the patients were 71.6 ± 9.9 and 82.9 ± 10.3, respectively. The KAP scores were significantly numerically improved, and the mean change in the KAP score was 11.3 ± 6.9 (P = 0.000).

Acknowledgment

The authors would be thankful to the NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Mangaluru, for providing the necessary research facilities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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