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      Opportunities to improve asthma and COPD prevention and care: insights from the patient journey obtained through focus groups


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          The healthcare experiences of patients hold valuable insights for improving the quality of services related to their well-being. We therefore invited and explored the perspectives of patients living with asthma and chronic obstructive pulmonary disease (COPD) on their interaction with the systems supporting health, in order to identify opportunities to improve services to prevent, treat and manage these conditions.


          Two virtual focus groups were held in August 2021, one for adult asthma and one for COPD, to learn of patients’ experiences receiving care for these conditions in the Vancouver Coastal Health (VCH) region of British Columbia. Participants were recruited through online postings or their clinician. We discussed the care pathway for each condition and invited participants to share their experiences of the past 5 years, specifically their reflections on the process, including feelings, points of praise and frustration, and opportunities for improvement in this context. Composite patient journey maps were developed for each condition to reflect the experiences shared. Audio recordings of the focus groups were transcribed and used in qualitative data analysis.


          Thematic analysis revealed the following as possible areas for improvement: low public awareness of asthma and COPD and associated risk factors, non-standardised diagnosis pathways that delay diagnosis, and inconsistency in delivering valued aspects of care such as supports for self-management, trust-inspiring acute care, empowering patient communication and timely access to care.


          We successfully used focus groups to generate composite journey maps of the experiences of patients living with asthma (n=8) and COPD (n=9) to identify features that these patients consider important for improving the healthcare system for asthma and COPD in VCH. Health professionals, decision makers and patient advocates in VCH and beyond can consider these insights when evaluating, and planning changes to, current practices and policies in service delivery.

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          Most cited references37

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          Using thematic analysis in psychology

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            Standards for reporting qualitative research: a synthesis of recommendations.

            Standards for reporting exist for many types of quantitative research, but currently none exist for the broad spectrum of qualitative research. The purpose of the present study was to formulate and define standards for reporting qualitative research while preserving the requisite flexibility to accommodate various paradigms, approaches, and methods.
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              Thematic analysis of qualitative data: AMEE Guide No. 131

              Thematic analysis is a widely used, yet often misunderstood, method of qualitative data analysis. It is a useful and accessible tool for qualitative researchers, but confusion regarding the method's philosophical underpinnings and imprecision in how it has been described have complicated its use and acceptance among researchers. In this Guide, we outline what thematic analysis is, positioning it in relation to other methods of qualitative analysis, and describe when it is appropriate to use the method under a variety of epistemological frameworks. We also provide a detailed definition of a theme, as this term is often misapplied. Next, we describe the most commonly used six-step framework for conducting thematic analysis, illustrating each step using examples from our own research. Finally, we discuss advantages and disadvantages of this method and alert researchers to pitfalls to avoid when using thematic analysis. We aim to highlight thematic analysis as a powerful and flexible method of qualitative analysis and to empower researchers at all levels of experience to conduct thematic analysis in rigorous and thoughtful way.

                Author and article information

                BMJ Open Qual
                BMJ Open Qual
                BMJ Open Quality
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                12 December 2023
                : 12
                : 4
                : e002403
                [1 ] departmentDivision of Respiratory Medicine , Ringgold_12358The University of British Columbia Faculty of Medicine , Vancouver, British Columbia, Canada
                [2 ] departmentLegacy for Airway Health , Ringgold_175184Vancouver Coastal Health Research Institute , Vancouver, British Columbia, Canada
                [3 ] departmentCenter for Lung Health , Ringgold_25469Vancouver Coastal Health Authority , Vancouver, British Columbia, Canada
                [4 ] departmentLegacy for Airway Health, Community Stakeholder Committee , Ringgold_175184Vancouver Coastal Health Research Institute , Vancouver, British Columbia, Canada
                [5 ] departmentDepartment of Physical Therapy , Ringgold_12358The University of British Columbia Faculty of Medicine , Vancouver, British Columbia, Canada
                [6 ] departmentDepartment of Family and Community Medicine , Ringgold_25469Vancouver Coastal Health Authority , Vancouver, British Columbia, Canada
                [7 ] departmentDepartment of Family Medicine , Ringgold_102794Providence Health Care , Vancouver, British Columbia, Canada
                Author notes
                [Correspondence to ] Professor Christopher Carlsten; carlsten@ 123456ubc.ca
                Author information
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                : 03 May 2023
                : 05 November 2023
                Funded by: Legacy for Airway Health;
                Award ID: no award/grant number
                Original Research
                Custom metadata

                asthma,patient participation,chronic disease management


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