The analysis of interviews resulted in the identification of two main categories and ten sub-categories (Table 1). For each of the main categories and sub- categories, relevant statements and quotation made by the interviewees will be presented.
Table 1: Main categories and sub-categories related to the impact of patient social network on Asthmatic patients
Patient's communication network
1. Motivating peers is a reason for self-care
2. Advice on lifestyle and self-care
3. Psycho-emotional support of the patient
4. Advice to avoid risky behaviors
5. Supporting position of experienced and committed medical staff
6. Get psychological counseling
Strengthen self-care behaviors
1. Pay attention to consumption and considerations of drugs
2. Add exercise to the life plan
3. Therapeutic recommendations are a factor in following a treatment regimen
4. Prevention of other aggravating diseases
1. Patient's communication network
Patient communication is one of the most important factors associated with the disease and recovery of Asthmatic patients. Therefore, to identify the position of each member of the communication network of Asthmatic patient, it is important to know the characteristics of the members of communication network.
Motivating peers is a reason for self-care
Each asthmatic patient has his or her own social network. These patients' social networks are tangible and affective in each other's healing process. These contributions can be from other patients as well as from people on others’ social networks.
Since patients are sensitive to disclosure of their health and medical information to others, they tend to communicate more easily with people they trust and talk to them about their illness. One patient in this regard said:
"I try not to talk too much about my illness, and only my husband and my father know about it. (P.7).
Without effective communication, no solid communication network will exist. People who have more communication abilities can be trusted by patients and gain their satisfaction. They also make patients to communicate more comfortably and talk about their problems more easily. One patient mentioned:
"Stress is very effective in asthma, so having a physician and a nurse who can communicate well and have a good morale helps you to control your asthma (P. 15).
"My mother can only calm me down whenever I get nervous and get short of breath. Otherwise I get angry and my asthma gets worse, so I think my mother has good communication skills (P. 22).
Advice on lifestyle and self-care
Lifestyle is a combination of behavioral patterns and individual habits throughout life, including nutrition, physical activity, stress, tobacco use, and quality of sleep that result from socialization. Lifestyle is a multifaceted phenomenon that encompasses all aspects of daily life such as sleep, food, health, customs, work, play, entertainment, leisure time, social relationships, mindset, behavior, and emotions. All patients, depending on their condition and level of illness, have some people on their social network who give advice on healthy lifestyle and how to improve it. One patient in this regard stated:
"My doctor has given me all the advice about the lifestyle I should have and has helped me a lot (P. 20).
"Everybody thinks that those with asthma can't exercise, but there are some sports that asthmatic people can do and I always suggest them to others (P. 26).
Patients use a variety of resources to protect and promote their health, including their own, other people, information available in the environment and specialists. There are several ways to perform self-care in patients with asthma. For example, one patient stated,
"My doctor has given me most of the education about self-care and diet. At home, my children tell me to wear mask when cooking and when is dusty. They tell me what to do so I don't feel bad (P. 30).
”All the things that I have to do for treatment, my daughter have asked the doctor and do them for me (P. 5).
Psycho-emotional support of the patient
The secret of patient care is the patient's emotional support. In asthma, the patient's mental state plays an important role in patient's health and asthma attacks, and psychological support reduces patient’s stress. Patients with poor mental health are more likely to develop asthma attacks and have a life-threatening illness. One patient stated:
"When my children and my husband take care of me and do not stress me at home, I do not feel bad at all. If I get nerves and stressed, I feel so bad" (P. 10).
"Nothing like the family can make a person calm and lift his/her moral in the stressful situations" (P. 36).
People and patients who are on another patient's social network can provide strong emotional support for that patient and give him hope that his illness can be cured by going through the course of treatment. Specialists also play an important role in providing emotional support for their patients. Emotional support of patients reduces stress and asthma attacks. One patient stated:
"I was very scared of asthma before and thought that it is an incurable disease. But when the doctor talked to me and said that with the use of sprays, my lungs would be repaired, I became less worried" (P. 15).
Stresses and psychological moods that Asthmatic or Allergic patients have are especially important, because they can play a role in exacerbating their disease. Most patients have a social-familial support network, but nonetheless, physician’s control and treatment of Asthma and allergies provides an additional source of support. Regular visits and easy access to doctor for unforeseen issues will definitely reduce anxiety. It also creates a sense of security and confidence in patient. For example, one patient said:
"I need medication and no stress and argument at home. I get really sick and short of breath when I get nervous. I get so much better when my daughters come to visit us from their towns "(P. 29).
Advice to avoid risky behaviors
In the patient's social network, there are people who engage in risky and harmful behaviors that are harmful to patient and these behaviors should be avoided as much as possible. Such high risk behaviors are also reported by the patients themselves and may pose a serious health risk to them. For example, one patient stated:
"Many people in the family ask me to quit smoking as I use opium" (P. 23).
“In relation to high-risk behaviors, I have been advised to stop smoking, and avoid going to places where there is smoke, or wear mask when I am cooking" (P. 22).
Patients' awareness of environmental stimuli has either been empirically tested or trained by experts. People who have just been diagnosed with asthma get their information through other patients on their social network. One patient in this regard stated:
"I can teach, for example, I say, don't smoke, don't walk in the dust, don’t go anywhere where people are smoking, do not keep a pet, or don’t use feather-filled pillow. We have asthmatic people in my mom’s family” (P. 7).
"In regard to the environmental stimuli, the physician told me to wear mask when the air is polluted, leave the places where there is smoke, and do not eat fast food" (P. 34).
Supporting position of experienced and committed medical staff
One of the needs of patients is the need for qualified medical staff. If the hospital treatment staff perform their duties properly and provide proper diagnosis and treatment, patients will be satisfied with their treatment. Most concerns of patients about the treatment staff is that, when they pay for their treatment, they want to see positive outcomes. Naturally, patients whose physicians have a high level of expertise are more satisfied with their physician, and they introduce them to other patients on their social network. Introduction of specialist physicians is also seen by other people on patient’s social network who are not ill, including family, friends, etc. One patient stated:
"I was hospitalized for my asthma. I live in another city, so I came to see a doctor in Kerman and she admitted me in the hospital and thanks to God I got better. The nurses worked very hard for me" (P. 5).
One patient in this regard stated: "A friend of mine introduced a physician to me for my asthma, and she has become my doctor since and I am very satisfied with her. So if I see someone who needs a specialist physician, I introduce her" (P. 7).
Get psychological counseling
Psychosocial factors play an important role in asthma. Psychological factors are often considered to be the underlying cause of the disease. Anxiety and depression, whether contributing to the onset of asthma or occurring during asthma, can cause asthma attack and affect quality of life. One patient in this regard stated:
"I have a lot of problems in my life. I need counseling. My husband left and I brought up four children alone. I always fought with myself. I really need a peaceful place” (P. 11).
Another patient stated: "I really have stress and problems at home. I need someone to really calm me down. I have a bad condition at home" (P. 28).
"I have a problem with my husband. Most of the time I get nervous and have asthma attack because I argue with my husband. I really need a psychiatrist" (P. 7).
2. Strengthen self-care behaviors
All diseases have their own care process and support needs, and asthma is no exception. Among the needs of asthmatic patients are the perceived and essentials need for disease treatment. Perceived needs are the needs that patient require and may not be necessary, but essential needs that are often diagnosed by a physician are the needs that improve patient’s condition and if neglected, they may endanger the health of patient.
Pay attention to consumption and considerations of drugs
One of the most basic needs of patients is the need for effective medications. Prescription of effective medications depends on accurate diagnosis, and the experience and expertise of the physician. One patient in this regard stated:
"I think you must first find a good asthma specialist to find out what makes you sick and give you good medication, not the ones that make your illness worse" (P. 33).
Most patients do not have enough information about the use of drugs that are harmful to asthma and allergies. So it can be said that, pharmacological counseling is one of the few important and effective measures in the treatment of asthma and all patients obtain their information from their doctor. One patient in this regard stated:
" I used to take ibuprofen or acetaminophen when I had a headache, but I did not know both of these pills would make me worse until I asked my doctor and he gave me a replacement medicine for my headache" (P. 27).
"Since I have had open heart surgery, I have to consult both my heart doctor and my asthma doctor, so that there would be no interference with my drugs" (P. 14).
Add exercise to the life plan
Exercise is beneficial for people with asthma and reduces the frequency of asthma attacks. The exercise of choice should be consistent with the patient's physical condition and health. People should consult their doctor before performing any exercise. In the area of exercise counseling in the patients' social network, information is provided to patient through a specialist physician. One patient in this regard stated:
"I can't do exercise. My doctor said I should only take a short walk in days when the weather is not polluted and in places where there is no flowers and plants. I have allergies and it gets worse if I don’t follow these rules" (P. 9).
Another patient stated, "My friend is studying medicine and says I can do swimming and cycling, so I go for swimming once a week" (P. 19).
"My doctor told me I can do some light exercises and I could go for a short walk" (P. 12).
Therapeutic recommendations are a factor in following a treatment regimen
Nutrition is one of the factors that contribute to the increase in the number of people with asthma. Proper nutrition can help relieve and improve asthma condition. The need for proper diet is seen in all asthmatic patients. Specialist nutrition for these patients is provided only by a specialist physician and nutritionist, and in some cases it is suggested to asthmatic patients empirically by others on their social network. One patient remarked:
"The diet and treatment that the doctor prescribed me (avoid eating certain foods) has helped me more than the things others suggested me. If I follow the regimen, I will feel much better during the day" (P. 34).
"I have not had any dietary counseling, but my uncle, who had asthma in the past, gave me some advice on foods" (P. 17).
Nutrition is one of the most important ways to control asthma attacks. The nutritional advice is first provided by the specialist physician on the patient's social network and then, by patient's experience and family. One patient said:
"I should not eat pickles and meat. There is smoke in the house that should not be. It is better not to smoke. Eating bad food will make me worse. Cold weather annoys me. I should adhere to diet that is given by my doctor” (P. 14).
"When I went to see the doctor, he wrote a dietary regimen on paper and told me what foods are not good for asthma. I follow them all" (P. 19).
Prevention of other aggravating diseases
Several factors are involved in exacerbation of asthma. One of these factors is other diseases that exacerbate asthma. These diseases can increase the incidence of asthma attacks and cause severe shortness of breath. Patients should prevent these diseases by adhering to health recommendations. One patient reported:
"In winter, when I get cold and my sinusitis worsens, I feel very bad and I get chest pain. The weather gets worse, so is my asthma" (P. 34).
"I just have to be careful not to get cold, because cold causes me to caught, and that makes my breathing worse" (P. 10).