INVESTIGATING THE PERSPECTIVES OF RESPIRATORY PHYSICIANS ON HOW SOCIAL DETERMINANTS OF HEALTH AND HEALTH LITERACY INFLUENCE ASTHMA OUTCOMES: A QUALITATIVE STUDY.

BACKGROUND: The present study sought to understand the role of social determinants on asthma outcomes through the perspectives of Iraqi respiratory physicians. METHODS: A qualitative study design with an interview guide was used to conduct semi-structured, in-depth interviews with respiratory physicians purposively selected from different tertiary healthcare centres (Baghdad, Iraq). Data was collected during a predefined study period and analysed through thematic analysis. Interviews were audio-recorded and transcribed verbatim, then iteratively coded to identify key themes and subthemes describing the perceived influence of social determinants of health (SDOH) and health literacy on asthma control, treatment adherence, and healthcare utilization. RESULTS: Seventeen respiratory physicians were interviewed. Thematic analysis revealed several interconnecting themes, such as socioeconomic barriers, environmental and occupational exposures, access to health care, and health literacy, which contribute to asthma control. Interviews with physicians identified several factors, including medication affordability, non-adherence to follow-up or doctors' recommendations, poor inhaler technique, and late presentation, as important factors explaining the suboptimum asthma outcome linked to disease progression and more frequent exacerbation. CONCLUSION: Impacts of social determinants of health on asthma outcomes from the insights of Iraqi respiratory physicians. To achieve optimal asthma control, socioeconomic inequalities must be addressed, and diversified efforts should focus on enhancing patient education and increasing healthcare accessibility.