Social Science & Medicine 53 (2001) 507–518
Variations in general practitioners’ views of asthma
management in four European countries
R. Wahlstro
¨
m
a,
*, P. Lagerlv
b
, C. Sta
˚
lsby Lundborg
a
, C.C.M. Veninga
c
,
E. Hummers-Pradier
d
, L.O. Dahlgren
e
, P. Denig
c
, the DEP group
1
a
Department of Public Health Sciences, IHCAR, Karolinska Institutet, SE-171 76Stockholm, Sweden
b
Department of Pharmacotherapeutics, University of Oslo, PO Box 1065 Blindern, NO-0316 Oslo, Norway
c
Department of Clinical Pharmacology, Northern Centre for Health Care Research, University of Groningen,
A. Deusinglaan 1, 9713 AV Groningen, Netherlands
d
Department of General Practice, University of Go
¨
ttingen, Robert-Koch-Str 42, D-37075, Germany
e
Department of Education and Psychology, University of Linko
¨
ping, SE-581 83 Linko
¨
ping, Sweden
Abstract
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: rolf.wahlstrom@phs.ki.se (R. Wahlstro
¨
m).
1
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