1. The Health and Wellbeing Study
Researchers June Considine , Mary Hughes
Presenter Michele Dunne

2. Introduction
Asthma is the most common chronic respiratory disease in Ireland with an estimated 470,000 individuals thought to be affected (7-8% of adults and 18-20% of children).
The loss of productivity in the workforce and at school due to asthma related illness is 12 days per adult and 10 days per child.
Roughly 1 person dies per week from asthma.

3. Background
Asthma is often distressing, debilitating and potentially life threatening, thus, the use of adequate treatment and management is essential in maintaining control.
The Asthma Society of Ireland is campaigning for the implementation of the National Clinical Programme for Asthma to improve the health and wellbeing for all those living with asthma in Ireland.
The aim of this is to reduce asthma bed days, decrease GP out of hours visits and reduce ED admissions over the next three years, plus achieving a 90% reduction in asthma mortality over a 10 year timeframe.

4. The Asthma Society has been investigating the lives of those living with asthma in relation to their health and wellbeing in order to support the call for implementation of the NCPA.
The Healthy Ireland Framework is a strategy to promote the health and wellbeing of the entire population over the coming decade.
The overall vision of the framework is to have an Ireland where every citizen can enjoy physical and mental health and wellbeing to their full potential.

5. The framework defines ‘Health’ as much more than an absence of disease or disability. It states that an ‘individual’s health and that of the country, affects the quality of a populations lived experience, is an essential aspect of everyday life and is an asset for all human development’. Wellbeing is highlighted as an important dimension in overall context of health.

6. Research Methodology
An online survey was used to explore the perceived health and wellbeing of adults living with asthma.
The study population was a convenience, self-selection sample recruited by online advertising.
An advertisement for the study was made available on the Asthma Society website, as well as the society’s social media sites and through the intranet network of University College, Cork.
Inclusion criteria included adults (aged 18+) who had an asthma diagnosis for one year or more and who had good English and I.T. skills.

7. Data collection and Analysis
Data were collected by online survey over a two week period (n=214).
The survey consisted of a 33 item instrument devised for the study and a section on demographics (short form version of the Medical Outcome Survey (Stewart et al. 1989), plus 8 items from the P105 Health and Wellbeing Instrument (Price et al 2014).
The reliability of the new instrument was confirmed in a pilot study, using 10 of the same population and the results were tested for face and construct validity.
Data were analysed using Statistical Package for the Social Sciences (SPSS software version 22).
Ethical approval was obtained from the local Research Ethics Board prior to commencing the study.

8. Findings
A total of 339 respondents completed the survey, but these were filtered were finally included for analysis.
Population: female (76%, n=162)
Age : 8% (n=18) aged 18 – 25
23% (n=49) aged 26 – 35
40% (n-85) aged 36-50
19% (n=40) aged 51 – 64
9% (n=21) aged 65+
1 respondent chose n0t to answer this question

9. Other co-existing illness reported
These were reported by 33% of participants (n=71) with 14% of the overall sample (n=30) reporting two or more coexisting illnesses.
Illnesses reported:
Hypertension 10.3% (n=22)
Depression 9.3% (n=20)
Chronic Obstructive Pulmonary Disease 6.1% (n=13)
Rheumatoid arthritis 2.8% (n=6)
Diabetes 2.3% (n=5)
Heart disease 1.9% (n=4)
‘Other’ option 15.9% (n=34) – allergic rhinitis, coeliac disease, eczema, hiatus hernia, factor V Leiden, thyroid abnormalities and epilepsy.

10. Employment status Full time employment was reported by 47% (n=101)
3% (n=7) reported being unemployed
7% (n=14) reported being unable to work due to permanent sickness or disability

11. Self perceived Asthma severity
6% (n=13) claimed to be ‘not at all serious’
31% (n=65) claimed to be ‘not very serious’
52% (n=110) claimed to be ‘fairly serious’
11% (n=24) claimed to be ‘very serious’

12. Physical health and daily activities
16% (n=33) had no form of limitation with daily activities
82% (n=175) had limitation with vigorous activity
7% (n=14) had difficulty with simple tasks such as washing and dressing
5% (n=11) were found to have ‘extreme’ limitation in social activities as a result of their physical health.

13. Physical ability
32% (n=68) were ‘somewhat satisfied’ with their physical ability
4% (n=9) were ‘completely satisfied’ with their physical ability
9% (n=19) reported ‘sleep’ being the daily activity most interfered with because of their physical health
8% (n=18) reported ‘recreational activities’ as the activity most interfered with because of physical health
80% (n=170) were found to have the ability to work at a paying job
20% (n=40) reported that they were unable to work due to their health

14. Influence of demographics on overall Health Score
Current employment was significant:
The mean health score was highest for those in the ‘working full time for payment or profit’ group.
Those who were ‘unable to work due to illness or disability’ presented with the lowest mean health score.
The Degree of severity was also identified as having influence:
The mean health score was highest for those in the ‘not at all serious’ group.
The lowest mean health score was found in the ‘very serious’ group.

15. Wellbeing When asked to rate their wellbeing
35% (n=74) reported ‘very good’ ,
34% (n=73) reported ‘good’
5% (n=11) reported ‘poor’
31% (n=66) were found to be ‘very happy’ with their personal life
28% (n=60) were ‘generally satisfied and pleased’
3% (n=6) were ‘very dissatisfied and unhappy.

16. Other issues 39% (n=84) reported no depressive symptoms
6% (n=12) admitted to feeling depressed ‘most of the time’
0.5% (n=1) reported feeling depressed ‘all of the time’
46% (n=99) reported feeling happy ‘most of the time’
22% (n=47) reported feeling happy only ‘some of the time’
0.9% (n=2) reported feeling happy ‘none of the time’

17. 38% (n=82) were close to and had social and loving relationships ‘all of the time’ in the past 4 weeks
26% (n=56) were close to and had social and loving relationships ‘most of the time’ in the past 4 weeks
0.5% (n=1) reported ‘never’ feeling loved or wanted in the past 4 weeks.
39% (n=84) reported never feeling isolated.
0.5% (n=1) reported feeling isolated ‘all of the time’

18. 51% (n=109) reported that their emotional health never interfered with their social activities
0.5% (n=1) reported an interference ‘all of the time’
36% (n=78) felt that their social limitations were ‘about the same’ as others their age
20% (n=44) reported that they were ‘much less’ limited than others their age
10% (n=21) reported that they were ‘much more’ limited than others their age

19. Discussion
The perceptions of both health and wellbeing were found to vary among the respondents in this study.
Co-morbidities and employment status were both found to have a significant influence on both self-rated health and wellbeing, with increasing asthma severity also being found to have a diminishing effect.
One third of respondents reported having co-existing illness, and over half considered their asthma to be severe.
Health status among this cohort of adults with asthma is in variance to the general population (Slan Study, Morgan et al. 2007) with fewer respondents rating their health as either ‘very good’ or ‘excellent’.

20. This is similar to findings in the ‘Living with Asthma’ study (Hughes & Dunne 2014) where participants considered themselves to be unhealthy and struggled to maintain their wellbeing.
This is noteworthy as it may be suggested that asthma affects health perceptions more than other chronic conditions and warrants further investigation.

21. Psychological wellbeing was also found to significantly influence overall health and wellbeing, with depressive symptoms being highlighted as a common co-morbidity, particularly among students and those aged 18 – 25yrs. Depression is often reported in conjunction with higher levels of anxiety also, and it is moderated by gender in young adults.
A small number of respondents reported having high levels of anxiety, with just under half reporting that their emotional health interfered with their social activities.

22. Levels of energy and vitality were also negative overall with over a quarter of all respondents feeling worn out, and over a third feeling tired.
The majority of respondents were found to be happy and satisfied with their personal life, a factor that was also highlighted as having a significant influence on their overall health and wellbeing.
The highest wellbeing scores were in those who were retired, but worryingly the lowest were among the student group.

23. Sleep quality was reported as poor with over twenty percent reporting trouble staying awake during the day, and experiencing poor or restless sleep and often being awoken short of breath.
Those in the 18 – 25 yrs age group reported the poorest sleep quality.
Overall sleep quality was also found to have a significant impact on health and wellbeing, with those experiencing better sleep reporting good self-perceived health status.

24. Conclusion
This study provides and in-depth insight into how people with asthma perceive their health and wellbeing.
Findings support the view that functional or disease status and measurement of symptom control should not be considered as the only measure of health.
Health and wellbeing should be addressed as separate, yet co-existing components in optimising the quality of life of people with asthma.

26. Thank You