Social Science & Medicine 53 (2001) 507–518
Variations in general practitioners’ views of asthma
management in four European countries
*, P. Lagerlv
, C. Sta
, C.C.M. Veninga
, L.O. Dahlgren
, P. Denig
, the DEP group
Department of Public Health Sciences, IHCAR, Karolinska Institutet, SE-171 76Stockholm, Sweden
Department of Pharmacotherapeutics, University of Oslo, PO Box 1065 Blindern, NO-0316 Oslo, Norway
Department of Clinical Pharmacology, Northern Centre for Health Care Research, University of Groningen,
A. Deusinglaan 1, 9713 AV Groningen, Netherlands
Department of General Practice, University of Go
ttingen, Robert-Koch-Str 42, D-37075, Germany
Department of Education and Psychology, University of Linko
ping, SE-581 83 Linko
The aim was to identify diﬀerences and similarities in views regarding asthma management among general
practitioners in four European countries (Germany, Netherlands, Norway and Sweden), and to explore reasons for sub-
optimal performance. The results are to be used for the development and tailoring of educational interventions. Semi-
structured interviews with 20 GPs in each country were conducted and analysed using a phenomenographic approach.
The domains of (i) general view of asthma, (ii) the doctor–patient relationship in managing asthma, and (iii) overall
management of asthma (treatment goals and evaluation of results) were approached during the interviews. There were
diﬀerent ways of experiencing phenomena related to asthma management both within and between the four countries.
Three general views on asthma were found where diﬀerent perspectives were emphasised: a medical, a ‘global’
(including community health, social and environmental aspects) and a patient’s perspective. Within the medical
perspective, only a few German doctors emphasised a psychological aetiology of asthma. The views on the doctor–
patient relationship described as ‘authoritarian’, ‘teaching’ or ‘empowering’ occurred similarly in all countries. The
majority of the doctors showed conﬁdence in the eﬀectiveness of the pharmaceutical treatment of asthma, some doctors
were concerned about limitations, but only in Germany a few doctors were explicitly critical of the values of
conventional pharmaceutical treatment. The main treatment goals were either conceived as getting the patient
symptom-free (Netherlands, Norway, and Germany) or to control the inﬂammatory process (Sweden). Several German
and some Norwegian doctors expressed the view that patients had to accept the disease and learn how to manage it,
while a few German doctors aimed at alternative treatments of asthma. The existence of qualitatively diﬀerent ways of
experiencing asthma management, both in and between countries, calls for consideration when trying to implement
general evidence-based treatment guidelines. A variation of approaches in continuing medical education for GPs is
needed to address such existing beliefs and conceptions that could sometimes be opposed to the content of educational
messages. # 2001 Elsevier Science Ltd. All rights reserved.
Keywords: Phenomenography; Asthma; General practice; Attitudes; Conceptions
*Corresponding author. Tel.: +46-8-517-76654; fax: +46-8-311-590.
E-mail address: firstname.lastname@example.org (R. Wahlstro
DEP (Drug Education Project) group include F.M. Haaijer-Ruskamp (international co-ordinator), P. Denig, and C.C.M. Veninga
(Netherlands); V. Diwan, G. Tomson, R. Wahlstro
m, T. Oke, and C. Sta
lsby Lundborg (Sweden); M. Andrew, I. Matheson
(deceased), M. Loeb, and P. Lagerlov (Norway); M.M. Kochen, and E. Hummers-Pradier (Germany).
0277-9536/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved.
PII: S 0277-9536(00)00356-7