Connecting Research with Reality: PhD student meets with Tower Hamlets residents to discuss living with asthma

One important area to study is which factors drive differences in wealth and impact people with asthma the most. There are differences in asthma outcomes, such as hospitalisations, severity and even death, depending on your background and where you live. Education, income, occupation, living conditions, resources, and opportunities available to people may also play a part. 

Understanding the Index of Multiple Deprivation (IMD)

These building blocks make up an index by which we can measure what is missing for people in a particular area. This is known as the “Index of Multiple Deprivation” or IMD. I hope to understand more about these "blocks" to living a full life with this condition and how they impact day-to-day asthma. While my research will look into anonymised patient data, shared personal experiences will bring that data to life and help me relate my findings to patients, the public, and policymakers.

Research Focus: Asthma Inequities in England

My PhD aims to identify and understand the socioeconomic and demographic factors that impact asthma in people in England from 2010 to 2021. I picked these years to capture the effects of two major events on asthma: the global financial crisis and the COVID-19 pandemic. 

I will use general practice and hospital records to look for differences in people with asthma and people in different positions in society and consider whether there are differences in age, sex, ethnicity, and other diseases linked with asthma in patients. The main findings will help tackle how income inequality contributes to differing asthma experiences across England.

Community Perspectives on Asthma

Interested in exploring the drivers behind these inequalities and engaging with underrepresented and underserved communities who spoke little English, I attended health charity Social Action for Health’s annual engagement event in Tower Hamlets. As part of the event, I had to present a research poster and deliver a 5-minute elevator pitch to local community members in attendance. Group discussions followed afterwards.

Tower Hamlets is one of the most deprived areas in the UK, so it was a good opportunity to put questions forward to the local community for their insights and perspectives. Was I adopting the right approach to the topic area? Did I need to reorient my focus? From Tower Hamlets’ point of view, which IMD domains (income, employment, education, health, crime, barriers to housing and services, and the living environment) contributed to inequalities in asthma and health? How do this domain and deprivation interact and affect residents’ daily lives? 

Their answers to these questions would provide context for my results, enrich my discussion section, and inform policy and research implications. By making this information available to the public, patients become aware and empowered of what issues may impact their asthma. Understanding health inequalities in asthma can support better local and national decision-making regarding the allocation of money and resources. This may help patients engage with healthcare and other services to help them avoid or reduce the triggers that can exacerbate their condition or lead to asthma attacks.

From these discussions, I was pleasantly humbled to learn that the least-weighted domains (Living Environment and Barriers to Housing & Services) were the most critical. Members cited overcrowding, poor housing conditions, ambient pollution, and limited green spaces as the main reasons for poorer asthma outcomes. While this might be an indictment of the housing crisis, it is worth closely investigating its role. Considering each domain contributes 9.3% to the overall IMD measure, do they play a significant role? If so, are they understated or underweighted in the index? This gave me some methodological food for thought in terms of isolating these domains in the analysis or conducting bespoke analyses to understand their significance better. 

I was further humbled to learn about members’ GP and hospital experiences. Members preferred visiting GPs over hospitals, which goes against reported perverse health-seeking behaviour. The literature reports that South Asian ethnic patients bypass primary care for emergency care as they are more likely to get the treatment they want. However, local community members, especially the older generation, are discouraged from going to the hospital because “once they go [or are admitted to A&E], they may never come back.” 

Meanwhile, patients mentioned communication barriers, claiming GPs misdiagnose their asthma, provide the wrong information, and underestimate the severity of their illness. They also rarely refer patients to asthma clinics or specialist care. This begs the question: What does this mean for reported asthma attacks, their severity and exacerbations? 

 I was blown away by the insights from local community members to the extent that I’ve had to change my approach — a sign of a successful event. You wouldn’t get this from papers, textbooks or seminars — the local community's wisdom is unmatched!

What next?

So, what next? Under/overreporting is an inherent data issue that can’t be addressed methodologically. Instead, I will provide context and review the literature to understand more about patients’ primary care experiences from deprived areas and the impacts on asthma care and outcomes, capturing the BAME community's perspective. 

I will derive the outcomes as planned and analyse the results with this key issue in mind to help inform the discussion and provide an area for further research – maybe as a postdoc! 

Who knows what the future holds? But I know one thing for sure: I will be there next year to reconnect with the local community, update them on my work and lean on their wisdom!

Acknowledgments

I’m very grateful for this experience. I want to thank the HDR UK Inflammation and Immunity Research Driver Programme Patient & Public Involvement members Dr Tracy Jackson for informing me of this opportunity and Karen Mooney for generously offering her advice, support and time during the summer. Karen’s comments on my poster and pitch ensured I was best prepared for the day.

I also want to thank Dr Stephanie Hanley from the University of Birmingham for funding and facilitating the event. Lastly, I want to thank Grainne, Ceri and the rest of the Social Action for Health team for organising the event, allowing me to engage with local community members and providing translation. Social Action for Health is a community-based health charity providing services and support to people most affected by health inequalities.

Zakariah Gassasse is a PhD student in Public Health at Imperial College London. His PhD thesis is titled “Exploring The Role Of Health Inequalities As Determined By Socioeconomic Status In The Diagnosis, Management and Outcomes Of Patients With Asthma In England”. Zakariah’s supervisors are Professor Jennifer Quint, Dr Hannah Whittaker, and Dr Constantinos Kallis.