Medication adherence in pediatric asthma: reasoning, responsibility, and behavior.

Successful asthma management in children requires an appropriate division of responsibility for management tasks between patient and their family. Non-adherence may result without appropriate assignment or acceptance of responsibility for these tasks. This study explored the relationship between selected child, caregiver, family, and asthma characteristics and responsibility for self-management activities. Child and caregiver perceived responsibility for selected tasks were determined and described via means and mean summary scores. Child, caregiver, family, and asthma characteristics were determined via interview and chart review and described by means or proportions. Pearson's correlation coefficient (r) examined any relationship between these characteristics and perceived levels of responsibility. Multiple regression examined whether the affect of child, caregiver, family, and asthma characteristics influenced perceived levels of responsibility for asthma management. One-hundred and four child and caregiver pairs were enrolled. Mean caregiver scores for all tasks suggest responsibility for each most of the time. The mean child scores for all tasks suggest an unwillingness to assume responsibility most or all of the time. Regression analysis indicated that patient age (r2 = 0.344), number of hospital admissions (r2 = 0.052), and PEF (r2 = 0.106) had the best predictive strength for the patient summary score. Only patient age (r = 0.486) was a significant predictor for the caregiver summary score. We conclude that children and caregivers perceive differently responsibility for asthma management tasks and patient age had the best predictive strength for both patient and caregiver responsibility.

Parent-youth teamwork in pediatric asthma management

To examine how asthma control is related to the association between the division of responsibility for asthma management and asthma-related quality of life among early adolescents. Forty-nine youth aged 10-15 years (Mage = 12.25, 57.1% female) with a physician-verified asthma diagnosis completed the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Asthma Control Test (ACT). Youth and their caregivers also completed the Asthma Responsibility Questionnaire (ARQ). Higher ACT scores indicate better asthma control. There was a significant difference in ARQ scores between youth and caregivers (p < .001, d = .94). Youth reported sharing equal responsibility for asthma management with caregivers, while caregivers reported having more responsibility relative to youth. Greater youth-reported ARQ (p = .004) and greater ACT scores (p < .001) were associated with higher PAQLQ scores. ACT scores moderated the effect of youth-reported ARQ on PAQLQ scores (p = .043). For youth with lower ACT scores, higher youth-reported responsibility was associated with higher PAQLQ scores; while for youth with higher ACT scores, PAQLQ scores were high regardless of perceived responsibility. The interaction between caregiver ARQ scores and ACT scores was not significant. This study suggests youth and caregivers report discrepant ARQ for asthma management tasks. Responsibility and level of asthma control are important factors for PAQLQ, with results indicating that fostering responsibility is an important factor, even among youth with poorly controlled asthma. Findings suggest that healthcare providers should assess family responsibility and help caregivers support adolescents in developing asthma management skills.

Adherence to asthma controller medications is suboptimal among adolescents. We evaluated predictors of adherence and longitudinal patterns of medication use between 8th and 10th grade among a sample of youth of diverse race/ethnicity. Eighth graders with asthma on controller medications (N = 62; 40.0% non-Latino white; 23.7% Black; 37.3% Latino; 37.3% female) completed measures of medication beliefs, responsibility for asthma management, and family cohesion. Objective methods tracked medication use longitudinally. Adherence declined during the high school transition, from 48.0% in eighth grade to 34.1% in tenth grade (F = 5.35, p < .01). Males had lower adherence (b = -10.11, SE = 5.37, p = .02, f2 = 0.11), as did Latino youth (b = -12.21, SE = 8.23, p = .03, f2 = 0.12). Family cohesion was associated with higher adherence (b = 4.38, SE = 1.98, p = .04, f2 = 0.06). Latent class models (LCMs) suggested a three-class model of longitudinal adherence patterns. This included low, declining adherence (Class 1 = 29%; higher proportion male, p = .02), high, sustained adherence (Class 2 = 26%, high family cohesion, p = .05, higher proportion female, p = .02), and low, sustained adherence (Class 3 = 45%; higher proportion Latino, p = .05, higher proportion male, p = .02). Asthma medication adherence declined between 8th and 10th grade. LCMs indicated some youth have stable patterns of adherence (high or low), whereas others demonstrate declines. Gender differences were observed, and family cohesion was associated with higher, sustained adherence. Interventions building on family resources and targeting the barriers adolescents face are necessary to improve asthma management during this vulnerable period.

Responsibility for Asthma Management Among Adolescents With and Without Attention-Deficit/Hyperactivity Disorder

Medication adherence in pediatric asthma: A systematic review of the literature.

The purpose of this study was to examine perceptions of children and parents regarding shared responsibilities for asthma management. The study included 72 children with asthma who were between the ages of 7 and 12 years and their parents. Asthma management responsibilities were assessed by the "Asthma Responsibility Questionnaire." Disagreements occurred between parents and children on assuming responsibility. Children reported higher asthma management responsibility scores than reported by parents for them. It is important that nurses provide education and counseling to both children and their families to ensure that children take responsibility for disease management.

Better understanding the influence and complexity of beliefs on medication adherence in asthma

BackgroundPoor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth.ObjectiveThis review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma.MethodsA systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed.ResultsIn total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects.ConclusionsThe mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.

Objective Asthma is common among Turkish schoolchildren, and teachers thus have considerable responsibility for asthma management in schools. However, there is no valid and reliable instrument to evaluate teachers’ asthma management self-efficacy in schools. The purpose of this study was to investigate the cross-cultural adaptation and psychometric properties of the Turkish version of the Asthma Self-Efficacy Scale (ASE-T) among elementary school teachers. Methods This methodological study included 216 elementary school teachers. The reliability of the ASE-T was expressed using Cronbach’s alpha coefficient and item-total score correlations. The validity of the scale was examined via confirmatory factor analysis, item analysis, and the content validity index. Results The Cronbach’s alpha coefficient of the scale was 0.70, and the item-total score correlations ranged between 0.24 and 0.57. The results of the confirmatory factor analysis determined the model fit indices to be χ2/df = 1.461, RMSEA = 0.046, GFI = 0.94, AGFI = 0.91, NNFI = 0.98, and CFI = 0.92. The item analysis results revealed the differences between teachers with low and high levels of self-efficacy. Conclusion The results indicated the usefulness of the ASE-T for Turkish teachers. It is essential to determine teachers’ competence in asthma management in order to improve their performance in school settings.

Although current asthma guidelines stress the importance of assessing and enhancing adherence to asthma treatment, medication adherence rates in asthma patients are consistently low in practice. In this review, we summarize current literature on method of measurement, prevalence, outcome and intervention of medication adherence in asthma patients. Nonadherence to prescribed treatment continues to be a frequent problem in patients with asthma even in recent years. Objective measurement of adherence should be implemented whenever possible. Review of pharmacy refill data or electronic monitoring of inhaler actuation may be a preferred method to assess adherence. Educational programmes should be specifically designed to address the unmet need and specific reasons for nonadherence for the target population. Large, well designed clinical trials to assess the efficacy of remote electronic monitoring and reminder systems to improve adherence are needed. There is an urgent clinical need for systematic, proven methods to assess and address medication nonadherence in asthma patients.

Our objectives were to examine how certain aspects of provider-patient communication recommended by national asthma guidelines (ie, provider asking for child and caregiver input into the asthma treatment plan) were associated with child asthma medication adherence 1 month after an audio-taped medical visit. Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All medical visits were audio-tape recorded. Children were interviewed 1 month after their medical visits, and both children and caregivers reported the child's control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence 1 month later. Children (n = 259) completed a home visit interview ∼1 month after their audio-taped visit, and 216 of these children were taking an asthma control medication at the time of the home visit. Children reported an average control medication adherence for the past week of 72%, whereas caregivers reported the child's average control medication adherence for the past week was 85%. Child asthma management self-efficacy was significantly associated with both child- and caregiver-reported control medication adherence. When providers asked for caregiver input into the asthma treatment plan, caregivers reported significantly higher child medication adherence 1 month later. Providers should ask for caregiver input into their child's asthma treatment plan because it may lead to better control medication adherence.

Introduction Medication nonadherence is a major problem in asthma management. Various factors such as patient-related, health systems, and socioeconomic status likely interact in a complex fashion to affect adherence, but their effects were previously mostly assessed in a unidimensional manner. This study aimed to explore the relationships between these factors and adherence in a multi-dimensional manner. Methods Asthma patients on maintenance inhalers for at least 12months completed a self-administered questionnaire to evaluate their adherence (Test of Adherence to Inhalers, TAI, questionnaire), health literacy (Short-form Health Literacy Instrument, HLS-SF12, questionnaire), illness beliefs (Brief Illness Perception Questionnaire, BIPQ), and medication beliefs (questions developed by study team), in addition to demographic, health systems and socioeconomic data. An initial model with hypothesized relationships between factors was developed after literature review. Exploratory factor analysis was performed to identify latent variables from observed variables. Confirmatory factor analysis was used to define factors and corroborate our initial model. Structural equation modeling (SEM) was then applied to evaluate our model and examine direct and indirect relationships among factors related to adherence. Statistical analyses were performed using STATA 17, with p&amp;lt;0.05 taken to be significant. Results300 patients managed in our hospital's clinics and inpatient wards from March 2021 to March 2024 completed the questionnaire. Mean age was 47±16years and 52.7% were females. 171 patients (57%) had poor adherence (TAI score ≤45). Our conceptual model (Figure 1) included 4 latent variables: health literacy, medication concerns, medication necessity, and socioeconomic status, and 2 observed variables: illness beliefs and having a regular doctor. Higher medication concerns decreased adherence (β = -0.278, p &amp;lt; 0.001) while higher perception of medication necessity increased adherence (β = 0.257, p = 0.003), both through direct effects. Higher health literacy increased adherence (β = 0.217, p &amp;lt; 0.001) indirectly through illness beliefs, medication concerns and medication necessity, but not directly. Having a regular asthma doctor increased adherence (β = 0.155, p = 0.004) both directly and indirectly through health literacy, illness beliefs, medication concerns and medication necessity. Greater illness beliefs (of severity) decreased adherence (β = -0.111, p &amp;lt; 0.001) indirectly through medication concerns, but not directly. Higher socioeconomic status increased adherence (β = 0.057, p = 0.027) indirectly through health literacy, illness beliefs and medication concerns, but not directly. Conclusion Health literacy, medication beliefs, illness beliefs, health systems, and socioeconomic status interact in a multidimensional manner to influence medication adherence in asthma.

Knowledge of Inhaled Therapy and Responsibility for Asthma Management Among Young Teens With Uncontrolled Persistent Asthma

The main purpose of this study was to evaluate the role of child behavior problems, parenting distress, and child routines in relation to children's adherence to daily medication in pediatric asthma. Participants included 45 asthmatic children and their families. Assessment included questionnaires, a medication dose-count monitor, and a brief telephone interview with the parent. Significant negative correlations were found between child care routines and both parenting distress and difficult child behavior. Medication adherence was significantly and positively correlated with both parental distress and difficult child behavior but was not significantly related to parent use of routines.