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Kolmodin MacDonell K, Bruzzese JM, Dinaj-Koci V, Gibson-Scipio W, Starbird W, Hall A, Dailey R, Jacques-Tiura AJ, Wang B. Predictors of adherence to controller medication in urban African American emerging adults with uncontrolled persistent asthma. J Asthma 2023; 60:1877-1884. [PMID: 37026716 DOI: 10.1080/02770903.2023.2196566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND African American emerging adults tend to have low adherence to asthma controller medication, as well as a disproportionate burden of asthma morbidity and mortality. This study explored constructs from the Information-Motivation-Behavioral Skills model as predictors of controller medication adherence in urban African Americans ages 18-29 (N=152) with uncontrolled asthma using multiple measures of self-reported adherence. METHODS Structural equation modeling (SEM) was employed to test the hypothesized mediation model that specified the relationship among psychological distress, substance use, asthma knowledge, motivation, self-efficacy, and adherence. RESULTS Results suggested that motivation is an important predictor of adherence to medication; moreover, higher self-efficacy was associated with higher motivation. Results also highlighted psychological distress as an important intervention target to improve medication adherence in emerging adults. CONCLUSIONS The model tested in this study may offer a feasible framework for beginning to understand adherence to controller medication in this population.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL, USA
| | | | | | | | - William Starbird
- College of Medicine, Central Michigan University, Mt Pleasant, MI, USA
| | - Amy Hall
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - Rhonda Dailey
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Bo Wang
- Chan School of Medicine, University of Massachusetts, Worcester, MA, USA
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Rhee H, Batek L, Rew L, Tumiel-Berhalter L. Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1510. [PMID: 37761471 PMCID: PMC10527731 DOI: 10.3390/children10091510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA;
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Hurtubise S, Perez T, Drouin O. L'adhérence au traitement de maladies chroniques chez les jeunes - Rôle du niveau d'actualisation et de la tolérance au risque. Paediatr Child Health 2023; 28:270-272. [PMID: 37484036 PMCID: PMC10362959 DOI: 10.1093/pch/pxac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/22/2022] [Indexed: 07/25/2023] Open
Abstract
Adolescents with chronic diseases must adhere to medication regimens to control their symptoms and avoid long-term complications. Despite its importance, medication adherence is low among adolescents. This commentary briefly covers the challenges described in the literature associated with measuring and addressing low medication adherence in adolescents. Next, it presents the evidence for the link between medication adherence and two prevalent psychological characteristics that have not been properly assessed so far: delay discounting (i.e., the relative value assigned to the future compared to the present), and risk tolerance. These psychological traits deserve further studies and are potentially amenable to interventions to improve medication adherence in adolescents with chronic conditions.
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Affiliation(s)
| | - Tamara Perez
- Centre de recherche du CHU Sainte-Justine, Canada
| | - Olivier Drouin
- Centre de recherche du CHU Sainte-Justine, Canada
- Service de pédiatrie générale, Département de pédiatrie, CHU Sainte-Justine; Montréal (Québec), Canada
- Département de pédiatrie, Université de Montréal, Canada
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Canada
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Frey SM, Fagnano M, Halterman JS. Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management. J Adolesc Health 2023; 72:623-628. [PMID: 36528520 PMCID: PMC10033387 DOI: 10.1016/j.jadohealth.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE It is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; 'accurate use'), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). METHODS We analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12-16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. RESULTS Of 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12-3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83-6.54), health care (OR: 0.39, 95% CI: 0.20-0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10-3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DISCUSSION Adolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.
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Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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5
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Drouin O, Perez T, Barnett TA, Ducharme FM, Fleegler E, Garg A, Lavoie K, Li P, Métras MÉ, Sultan S, Tse SM, Zhao J. Impact of Unmet Social Needs, Scarcity, and Future Discounting on Adherence to Treatment in Children With Asthma: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e37318. [PMID: 36881458 PMCID: PMC10131837 DOI: 10.2196/37318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most prevalent chronic diseases of childhood and disproportionately affects children with lower socioeconomic status. Controller medications such as inhaled corticosteroids significantly reduce asthma exacerbations and improve symptoms. However, a large proportion of children still have poor asthma control, in part owing to suboptimal adherence. Financial barriers contribute to hindering adherence, as do behavioral factors related to low income. For example, unmet social needs for food, lodging, and childcare may create stress and worry in parents, negatively influencing medication adherence. These needs are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting; thus, there is the tendency to attribute greater value to the present than to the future in making decisions. OBJECTIVE In this project, we will investigate the relationship between unmet social needs, scarcity, and future discounting as well as their predictive power over time on medication adherence in children with asthma. METHODS This 12-month prospective observational cohort study will recruit 200 families of children aged 2 to 17 years at the Asthma Clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. The primary outcome will be adherence to controller medication, measured using the proportion of prescribed days covered during follow-up. Exploratory outcomes will include health care use. The main independent variables will be unmet social needs, scarcity, and future discounting, measured using validated instruments. These variables will be measured at recruitment as well as at 6- and 12-month follow-ups. Covariates will include sociodemographics, disease and treatment characteristics, and parental stress. Primary analysis will compare adherence to controller medication, measured using the proportion of prescribed days covered, between families with versus those without unmet social needs during the study period using multivariate linear regression. RESULTS The research activities of this study began in December 2021. Participant enrollment and data collection began in August 2022 and are expected to continue until September 2024. CONCLUSIONS This project will allow the documentation of the impact of unmet social needs, scarcity, and future discounting on adherence in children with asthma using robust metrics of adherence and validated measures of scarcity and future discounting. If the relationship between unmet social needs, behavioral factors, and adherence is supported by our findings, this will suggest the potential for novel targets for integrated social care interventions to improve adherence to controller medication and reduce risk across the life course for vulnerable children with asthma. TRIAL REGISTRATION ClinicalTrials.gov NCT05278000; https://clinicaltrials.gov/ct2/show/NCT05278000. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37318.
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Affiliation(s)
- Olivier Drouin
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Tamara Perez
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Tracie A Barnett
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Francine M Ducharme
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Clinical Research and Knowledge Transfer Research Centre, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center and School of Medicine, Boston University, Boston, MA, United States
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, QC, Canada
- Department of Psychology, Université de Quebec à Montreal, Montreal, QC, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
- Division of General Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marie-Élaine Métras
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Serge Sultan
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Sze Man Tse
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Jiaying Zhao
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, BC, Canada
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Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1573. [PMID: 36291509 PMCID: PMC9600616 DOI: 10.3390/children9101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | | | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 77 Goodell St., Buffalo, NY 14203, USA
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Camp-Spivey LJ, Logan A, Nichols M. Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review. J Child Health Care 2022; 26:242-261. [PMID: 33913767 DOI: 10.1177/13674935211013697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl's methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.
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Affiliation(s)
- Logan J Camp-Spivey
- College of Nursing, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Ayaba Logan
- Libraries Department of Research & Education Services, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, 2345Medical University of South Carolina, Charleston, SC, USA
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8
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Adherence to inhaled corticosteroids prescribed once vs twice daily in children with asthma. Ann Allergy Asthma Immunol 2022; 128:423-431.e3. [PMID: 35077865 DOI: 10.1016/j.anai.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suboptimal adherence to inhaled corticosteroids (ICS) is associated with poor asthma control. Adult studies suggest that simplification of ICS regimen leads to better adherence. OBJECTIVE We aimed to determine whether once-daily, compared with twice-daily, ICS dosing was associated with better adherence among children with asthma. METHODS We conducted a retrospective observational study of children with asthma prescribed with either once-daily or twice-daily ICS monotherapy between 2011 and 2019. Our primary adherence outcome was the proportion of prescribed days covered (PPDC)-that is, the number of days for which the drug was dispensed by the pharmacy divided by the number of days for which it was prescribed. The impact of once-daily vs twice-daily ICS regimen on adherence was evaluated using linear multivariable regression analysis adjusting for covariates. Secondary outcomes included the proportion of patients with greater than or equal to 75% adherence analyzed using logistic regression models. RESULTS A total of 232 children (61% boys; mean age of 5.8 [3.6] years) were included; 120 children were prescribed once-daily, and 112 twice-daily, ICS. The median PPDC was 66.8% for the once-daily and 57.9% for the twice-daily group (P = .03). Children prescribed once-daily ICS had a 7.2% (95% confidence interval, 1.3-13.1) greater mean PPDC compared with the twice-daily group and greater odds of having PPDC greater than or equal to 75% (71.4% vs 45.5%; odds ratio, 1.80; 95% confidence interval, 1.01-3.26). CONCLUSION Our findings suggest that once-daily dosing of ICS is associated with better medication adherence than twice-daily dosing. Whether the gain in adherence leads to better asthma control and health outcomes remains to be evaluated.
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Leonard SI, Turi ER, Powell JS, Usseglio J, Kolmodin MacDonell K, Bruzzese JM. Associations of asthma self-management and mental health in adolescents: A scoping review. Respir Med 2022; 200:106897. [PMID: 35714575 PMCID: PMC9871877 DOI: 10.1016/j.rmed.2022.106897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship. AIM This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships. METHODS Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date. RESULTS Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied. CONCLUSION Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.
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Affiliation(s)
- Sarah I. Leonard
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Eleanor R. Turi
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Jennifer S. Powell
- Division of Global and Community Health, Medical University of South Carolina
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center
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Takkinsatian P, Chantaratin S, Sirisakpanit S, Srisuwatchari W, Pacharn P, Jirapongsananuruk O, Visitsunthorn N. Psychosocial factors and lack of asthma knowledge undermine child and adolescent adherence to inhaled corticosteroid. J Asthma 2021; 59:2234-2245. [PMID: 34752204 DOI: 10.1080/02770903.2021.1999468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with non-adherence in pediatric asthma patients. A total of 134 patients aged 8-18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (<75%). "Intentional" and "hectic lifestyle and forgetfulness" were the main reasons for missing ICS doses in mid-late adolescents and children, respectively. Asthma knowledge generally improved with age. Overall, 89% and 67.7% of patients could define symptoms and triggers of asthma, respectively; however, less than 25% understood how asthma affected their body and the chronic nature of asthma. Patients with ICS adherence <75% had unfavorable expectations from asthma treatment (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.10), and a higher proportion of inhaled short-acting beta-agonist use before exercise (OR: 4.12, 95% CI: 1.27-13.36). Depression and anxiety were frequently found (27.5%) and 23.3%, respectively; p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.
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Affiliation(s)
- P Takkinsatian
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Chantaratin
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Sirisakpanit
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - W Srisuwatchari
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Pacharn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - O Jirapongsananuruk
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Visitsunthorn
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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11
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Moore A, Preece A, Sharma R, Heaney LG, Costello RW, Wise RA, Ludwig-Sengpiel A, Mosnaim G, Rees J, Tomlinson R, Tal-Singer R, Stempel DA, Barnes N. A randomised controlled trial of the effect of a connected inhaler system on medication adherence in uncontrolled asthmatic patients. Eur Respir J 2021; 57:13993003.03103-2020. [PMID: 33334936 PMCID: PMC8176348 DOI: 10.1183/13993003.03103-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022]
Abstract
Suboptimal adherence to maintenance therapy contributes to poor asthma control and exacerbations. This study evaluated the effect of different elements of a connected inhaler system (CIS), comprising clip-on inhaler sensors, a patient-facing app and a healthcare professional (HCP) dashboard, on adherence to asthma maintenance therapy. This was an open-label, parallel-group, 6-month, randomised controlled trial in adults with uncontrolled asthma (asthma control test (ACT) score less than 20) on fixed-dose inhaled corticosteroids/long-acting β-agonist maintenance therapy (n=437). All subjects received fluticasone furoate/vilanterol ELLIPTA dry-powder inhalers for maintenance and salbutamol/albuterol metered-dose inhalers for rescue, with a sensor attached to each inhaler. Participants were randomised to one of five CIS study arms (allocation ratio 1:1:1:1:1) reflecting the recipient of the data feedback from the sensors, as follows: 1) maintenance use to participants and HCPs (n=87); 2) maintenance use to participants (n=88); 3) maintenance and rescue use to participants and HCPs (n=88); 4) maintenance and rescue use to participants (n=88); and 5) no feedback (control) (n=86). For the primary endpoint, observed mean±sd adherence to maintenance therapy over months 4–6 was 82.2±16.58% (n=83) in the “maintenance to participants and HCPs” arm and 70.8±27.30% (n=85) in the control arm. The adjusted least squares mean±se was 80.9±3.19% and 69.0±3.19%, respectively (study arm difference: 12.0%, 95% CI 5.2–18.8%; p<0.001). Adherence was also significantly greater in the other CIS arms versus the control arm. The mean percentage of rescue medication free days (months 4–6) was significantly greater in participants receiving data on their rescue use compared with controls. ACT scores improved in all study arms with no significant differences between groups. A CIS can improve adherence to maintenance medication and reduce rescue medication use in patients with uncontrolled asthma. In individuals with uncontrolled asthma, data feedback on maintenance therapy use from a connected inhaler system led to increased maintenance adherence and feedback on rescue medication usage led to more rescue-free days but did not improve asthma controlhttps://bit.ly/39kmVBA
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Affiliation(s)
| | | | | | - Liam G Heaney
- Queen's University Belfast, Belfast, UK.,United Kingdom Medical Research Council Refractory Asthma Stratification Programme
| | - Richard W Costello
- United Kingdom Medical Research Council Refractory Asthma Stratification Programme.,Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | | | | | | | | | | | | | - Neil Barnes
- GlaxoSmithKline R&D, Brentford, UK.,St Bartholomew's Hospital, London, UK
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Sloand E, Butz A, Rhee H, Walters L, Breuninger K, Pozzo RA, Barnes CM, Wicks MN, Tumiel-Berhalter L. Influence of social support on asthma self-management in adolescents. J Asthma 2021; 58:386-394. [PMID: 31771375 PMCID: PMC7269846 DOI: 10.1080/02770903.2019.1698601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Adolescents with asthma are influenced by peers and family. The objective was to better understand family social support and test its association with medication adherence, asthma control, and Emergency Department (ED) use. METHODS This study is a cross-sectional secondary data analysis from a randomized controlled trial with urban adolescents from three U.S. cities. Participants (12-20 years old) with asthma completed the Perceived Family Support Scale (PFS) and Horne's Medication Adherence Report Scale (MARS). Data from both tools were classified into 2 categories- high and low (< 25th percentile) perceived family support and high (total score >10) and low medication adherence, respectively. Chi-square statistic and logistic regression were used for analysis. RESULTS Of the 371 participants, the majority were young (96% ≤ 17 years), African American or Bi-racial (85%), and Medicaid-insured (72%); over one-third had maternal family history of asthma. Among those on a controller medication (n = 270), only 37% reported its use ≥8 days over 2 weeks. Asthma control was poor with 50% categorized "not well controlled," 34% "very poorly controlled." Participants responded positively to most social support items. One item, providing and receiving social support to and from family members, was less often positively reported. Low medication adherence was significantly associated with lower perceived social support (p = 0.018). CONCLUSION This study underscores the importance of family social support in understanding the extent of adolescents' self-management, particularly medication adherence.
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Affiliation(s)
| | - Arlene Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Leanne Walters
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Kathleen Breuninger
- Primary Care Pediatric Nurse Practitioner, Park Pediatrics, Takoma Park, MD, USA
| | | | - Christina Marie Barnes
- Pediatric Nurse Practitioner, Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mona Newsome Wicks
- Health Promotion and Disease Prevention Department, University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
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McQuaid EL, Kopel SJ, Seifer R, Tackett A, Farrow M, Koinis-Mitchell D, Dunsiger S. Patterns of Asthma Medication Use across the Transition to High School. J Pediatr Psychol 2021; 46:578-587. [PMID: 33550368 DOI: 10.1093/jpepsy/jsab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Department of Pediatrics, Alpert Medical School, Brown University
| | - Sheryl J Kopel
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University
| | - Ronald Seifer
- The University of North Carolina at Chapel Hill; Frank Porter Graham Child Development Institute
| | - Alayna Tackett
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Institute for Addiction Science
| | | | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Department of Pediatrics, Alpert Medical School, Brown University
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health
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14
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Marckmann M, Hermansen MN, Hansen KS, Chawes BL. Assessment of adherence to asthma controllers in children and adolescents. Pediatr Allergy Immunol 2020; 31:930-937. [PMID: 32574387 DOI: 10.1111/pai.13312] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Low adherence to asthma controllers is known to increase the risk of uncontrolled disease and poor health outcomes. We aimed to study risk factors of long-term adherence to preventive medications in children and adolescents with asthma. METHODS Adherence was assessed during a two-year period in 155 children with asthma followed in a tertiary pediatric asthma outpatient clinic using percentage of days covered (PDC) based on physician prescriptions and pharmacy claims data. The risk factor analysis included age, sex, ethnicity, BMI, atopic comorbidity, spirometry incentives, and fractional exhaled nitric oxide (FeNO). RESULTS Ninety-five children, 50 (53%) males, mean age of 16.3 years (SD, 2.36), received at least one prescription for asthma controllers in the study period. Fifty-two (54%) children were classified as non-adherent with a PDC cutoff at 80%. Adherence was negatively associated with age: adherence ratio (AR) 0.84 (95% CI, 0.73-0.95), P = .008; forced expiratory volume in 1 second (FEV1): AR per L 0.6 (0.91-1.0), P = .03; unfilled inhaled beta-2-agonist prescription: AR 0.45 (0.23-0.89), P = .02; and FeNO level: AR per ppb 0.98 (0.97-0.99), P = .03, where age and FeNO retained significance in multivariate analysis. Type and number of asthma controllers were not associated with adherence. CONCLUSIONS This study shows low adherence to preventive medication among half of the children with asthma, which is associated with increasing age and FeNO level. Therefore, an extra effort should be directed toward teenagers transitioning from pediatric to adult medicine and toward inhaled corticosteroid-treated patients with elevated FeNO to increase their adherence to asthma controllers.
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Affiliation(s)
- Mads Marckmann
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette N Hermansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten S Hansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Allergy Clinic, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L Chawes
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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15
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Foster JM, Beasley R, Braithwaite I, Harrison T, Holliday M, Pavord I, Reddel HK. Patient experiences of as-needed budesonide-formoterol by Turbuhaler® for treatment of mild asthma; a qualitative study. Respir Med 2020; 175:106154. [PMID: 33190085 DOI: 10.1016/j.rmed.2020.106154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/29/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Combination low-dose budesonide-formoterol, taken as-needed for symptom relief reduces exacerbation risk and is recommended for treatment of mild asthma. The NovelQ qualitative study explored patients' attitudes toward using this novel therapy. METHODS Adults with mild asthma using reliever-only treatment were randomised to as-needed budesonide-formoterol Turbuhaler® in a multinational, 52-week open-label randomised controlled trial (NovelSTART-ACTRN12615000999538). A subgroup were interviewed to explore their attitudes to use of as-needed budesonide-formoterol after receiving it for ≥10 months. Semi-structured interviews were conducted until saturation, audio-recorded, and thematically analysed. RESULTS Analysis of 35 participants (66% female; mean age 43.5 [range 18-74]; mean Asthma Control Questionnaire score 1.09 ± SD0.55) interviews identified 5 themes, each including both barriers and facilitators to therapy use. Themes were: 'Treatment effectiveness' i.e. how well symptoms were relieved and/or prevented; 'Lifestyle fit of the regimen' e.g. the extent to which the treatment regimen integrated into the patient's daily life; 'Attitudes toward medication use and safety' e.g. openness for new reliever treatments, beliefs about treatment necessity or side effects; 'Device attributes' e.g. perceived ease of use; and 'Doctor-patient relationship' e.g. impact of health professional support on new treatment acceptance. CONCLUSIONS A wide range of factors seem to drive the opinions of mild asthma patients on as-needed budesonide-formoterol therapy. Many patients perceived both positive and negative treatment attributes, and their individual evaluation of these attributes determined their likelihood of using it after the study. Supportive patient-physician interactions appear key to addressing patient barriers. Recommendations for patient-centred discussions, developed from this research, are provided.
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Affiliation(s)
- J M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - R Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - I Braithwaite
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - T Harrison
- Nottingham Respiratory Medicine Unit and NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.
| | - M Holliday
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - I Pavord
- Respiratory Medicine Unit, Oxford Respiratory NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - H K Reddel
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
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16
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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Miadich SA, Everhart RS, Greenlee J, Winter MA. The impact of cumulative stress on asthma outcomes among urban adolescents. J Adolesc 2020; 80:254-263. [PMID: 32222611 DOI: 10.1016/j.adolescence.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/11/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Many families living in low-income, urban areas experience a number of stressors (e.g., poverty, neighborhood stress, family functioning) that place adolescents at risk for worse asthma outcomes. Adolescents may face additional challenges (e.g., peer pressure, school stress) that add to their overall stress and influence their disease care and health outcomes. The current study examined the impact of a cumulative risk model of stressors including poverty, neighborhood stress, school stress, peer pressure, and caregiver-adolescent conflict on asthma outcomes (e.g., emergency department [ED] visits, asthma control, quality of life [QOL]) among urban adolescents (13-17 years). METHODS Data were collected from 61 urban families of adolescents with asthma (54.1% female; 93.4% African American) in the United States. Caregivers and adolescents completed questionnaires assessing stressors and asthma outcomes separately during a research session. RESULTS Cumulative risk was significantly associated with worse adolescent QOL and asthma control, and more ED visits. The cumulative risk index was also a more robust predictor of QOL and asthma control than any one individual predictor. Poverty, neighborhood stress, and school stress emerged as individual predictors of ED visits. Further, adolescents with well-controlled asthma had significantly lower neighborhood and school-related stress scores. CONCLUSIONS Findings suggest that beyond the risk conferred by individual risk factors, an accumulation of stress can have an especially negative impact on asthma outcomes for urban adolescents. Future intervention work aimed at improving asthma outcomes should consider incorporating strategies for minimizing overlapping sources of stress in adolescents' daily lives.
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Affiliation(s)
- Samantha A Miadich
- Department of Psychology, Arizona State University, Tempe, AZ, USA; Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, 23284-2018, VA, USA.
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, 23284-2018, VA, USA
| | | | - Marcia A Winter
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, 23284-2018, VA, USA
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18
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Foronda CL, Muheriwa SR, Fernandez-Burgos M, Prather S, Nersesian P. Medication Adherence of Latino Children and Caregivers: An Integrative Review. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:207-213. [PMID: 31888391 DOI: 10.1177/1540415319896623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There are significant disparities in medication adherence among underserved minority groups such as Latinos. Adherence to medication is a primary determinant of treatment success. Little is known about medication adherence among Latino children. This integrated review aims to describe what is known about medication adherence among Latino children and explore barriers and facilitators to medication adherence. METHOD This review was guided by Whittemore and Knafl's method of integrative review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RESULTS Of the 20 articles reviewed about medication adherence among Latino children, the analysis of these articles revealed four major themes: (1) low adherence, (2) low adherence associations, (3) child outcomes, and (4) effective interventions. CONCLUSION Health practitioners should consider medication adherence associations and interventions when collaborating with the family caregiver to improve child outcomes.
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Frey SM, Contento NC, Halterman JS. Nurse-delivered outpatient asthma education for children and caregivers: a pilot study to promote shared asthma management. J Asthma 2019; 58:413-421. [PMID: 31739709 DOI: 10.1080/02770903.2019.1692028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the feasibility of nurse-delivered asthma education for caregiver/child dyads in a busy clinic setting, and measure the preliminary effectiveness of the intervention. METHODS We conducted a pilot study of nurse-delivered asthma education in a busy outpatient clinic. We enrolled a convenience sample of children (7-16 years) with uncontrolled persistent asthma who had a prescription for an inhaled controller medication and public health insurance. After provider visits, nurses taught dyads using picture-based materials, teach-back methods, and colored labels applied to asthma medications. The intervention was repeated at 1-month follow-up. We assessed feasibility by reviewing nurse documentation in the electronic medical record, detailing whether each component was implemented and the time required for education at each visit. We measured preliminary effectiveness by surveying children and caregivers separately before each clinic visit about asthma management responsibility, self-efficacy, caregiver quality of life, and symptoms; caregivers also completed a final telephone survey 2 months after the follow-up visit. We examined pre-post differences in continuous outcomes within-subjects using Wilcoxon signed rank tests. RESULTS We enrolled 22 child/caregiver dyads. Nursing documentation indicated a high rate of component delivery at each visit; the initial and 1-month visits required 25 and 15 min, respectively. We observed significant increases in child responsibility, child/caregiver self-efficacy, caregiver quality of life, and child symptoms at each follow-up. CONCLUSION This intervention of patient-centered asthma education can be delivered by nurses to caregiver/child dyads with high fidelity in a busy pediatric practice. Preliminary data indicate potential benefit for both children and caregivers.
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Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nicholas C Contento
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Tam-Williams JB, Jones BL. Closing the gap: Understanding African American asthma knowledge and beliefs. Ann Allergy Asthma Immunol 2019; 121:458-463. [PMID: 30021120 DOI: 10.1016/j.anai.2018.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND African American children are disproportionately affected by asthma (13% vs 8% non-Hispanic white Americans) and experience 30% higher asthma-related deaths than whites. Knowledge regarding asthma and asthma treatment among African Americans has been postulated as a potential contributor to this observed health disparity. Compared with the amount of studies on asthma, few investigations provide insight into the baseline knowledge and beliefs of African Americans regarding asthma. OBJECTIVE Assess knowledge and beliefs regarding asthma symptoms, diagnosis, treatment, prognosis, and stigmas in a general community sample of African Americans. METHODS Using community-based participatory research techniques, we developed and implemented a cross-sectional survey to explore asthma knowledge and beliefs among African American adults in a Midwestern city. RESULTS Among the 158 African American adults who completed the survey, general asthma knowledge was good, with awareness of the genetic contribution to asthma and general asthma symptomatology (eg, 92% aware of nighttime cough as a symptom). However, asthma-related misconceptions were also revealed. Thirty-three percent of respondents were concerned about addiction to asthma medication, and 60% of respondents believed that inhaled corticosteroids were dangerous or did not know. CONCLUSION This study reveals important insights into asthma knowledge and beliefs among African Americans that may be used to address disparities in asthma outcomes in this population.
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21
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Ndefo UA, Davis PN, Henry A. Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma. J Am Pharm Assoc (2003) 2019; 59:521-526. [PMID: 31036527 DOI: 10.1016/j.japh.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING A local Medicaid managed care organization. PARTICIPANTS Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.
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Teufel Ii RJ, Patel SK, Shuler AB, Andrews AL, Nichols M, Ebeling MD, Dawley E, Mueller M, Ruggiero KJ, Treiber FA. Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study. JMIR Pediatr Parent 2018; 1:e8. [PMID: 31518299 PMCID: PMC6716478 DOI: 10.2196/pediatrics.9796] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/24/2018] [Accepted: 06/28/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Youth with asthma who have poor medication adherence, have limited access to care, and are frequently seen in the acute care setting are often termed "high risk." OBJECTIVE This study aimed to design and test the feasibility of using smartphone technology to assess contextual factors that may impact changes in daily medication adherence and to identify new symptom episodes among high-risk youth with asthma in their home environment. METHODS Youth aged 8-17 years with high-risk asthma from 2 children's hospitals were eligible for the 2-month study. An app was downloaded on participants' phones at enrollment. Daily text message (short message service) reminders were sent to complete ecological momentary assessment of asthma symptoms and other contextual factors such as emotional state using the app. Bluetooth inhaler devices were used to record timestamps of inhaler use with the ability to review and manually enter data. The acceptability was assessed with surveys, key informant interviews (KII), and frequency of days with asthma data. KII data were used in an iterative design approach to identify challenges, strengths, and suggestions for maximizing use. Generalized linear mixed modeling was used to preliminarily explore contextual factors associated with changes in daily adherence. RESULTS We enrolled 14 children aged 8-16 years (13/14, 93% were African Americans). Over the 2-month study period, participants reported coughing (42/110, 38%), wheezing (8/111, 7%), chest tightness (9/109, 8%), boredom (57/109, 52%), and 10 new asthma symptom episodes. The controller medication adherence was 30%, which increased significantly on days with asthma symptoms or boredom. Data were received on 89% (606/681) of study days. Surveys and KIIs suggest acceptability among youth and their caregivers. Challenges reported during the study included lost or damaged phones and available memory. CONCLUSIONS Youth and their caregivers reported the acceptability of using smartphones for real-time asthma monitoring. Overall, the controller medication adherence was low but increased significantly on days with reported asthma symptoms or boredom, suggesting that daily contextual factors may be associated with a change in the adherence behavior.
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Affiliation(s)
- Ronald John Teufel Ii
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Sachin K Patel
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Anita B Shuler
- Children's Hospital, Medical University of South Carolina, Charleston, SC, United States
| | - Anne L Andrews
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Myla D Ebeling
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Erin Dawley
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Kenneth J Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Frank A Treiber
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
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Desager K, Vermeulen F, Bodart E. Adherence to asthma treatment in childhood and adolescence - a narrative literature review. Acta Clin Belg 2018; 73:348-355. [PMID: 29228891 DOI: 10.1080/17843286.2017.1409684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We provide a narrative literature review on surveys used to assess the level of medication adherence in children and adolescents with asthma, the attitudes of these patients and their parents toward asthma therapy, and their expectations concerning asthma and available treatment. METHODS A PubMed search and manual selection of the retrieved papers was conducted to identify studies using surveys or interviews that addressed one of the three topics of interest. RESULTS Adherence to asthma medication varies across age groups and with the type of measurement used. Levels of 49-71% were observed in children and adolescents by objective measurements. Subjective measurements overestimate the level of adherence compared to objective measurements. A considerable percentage of parents expressed fear of side effects of inhaled corticosteroids, although the impact of these concerns on adherence is unclear. Many adolescents and parents adapt inhaled corticosteroids use according to the prevalence of asthma symptoms, by reducing or eliminating controller medication in the absence of symptoms. Pediatric asthma patients and their parents tend to overestimate the level of asthma control, either by underestimating asthma severity or by assuming that a better control is not possible. The knowledge of parents and adolescents concerning asthma management is suboptimal; moreover, insufficient knowledge about inhaled corticosteroids was linked to poor adherence. CONCLUSION Medication adherence is crucial for a good control of asthma symptoms. Additional research concerning the triggers of non-adherence is still needed. Educating both the patients and their parents on proper asthma care might improve adherence.
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Affiliation(s)
- Kristine Desager
- Department of Pediatrics, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Françoise Vermeulen
- Department of Pediatrics, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Eddy Bodart
- Department of Pediatrics, Université Catholique de Louvain (UcL), CHU Dinant Godinne/UCL Namur, Yvoir, Belgium
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Doupnik SK, Lawlor J, Zima BT, Coker TR, Bardach NS, Rehm KP, Gay JC, Hall M, Berry JG. Mental Health Conditions and Unplanned Hospital Readmissions in Children. J Hosp Med 2018; 13:445-452. [PMID: 29964274 DOI: 10.12788/jhm.2910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mental health conditions (MHCs) are prevalent among hospitalized children and could influence the success of hospital discharge. We assessed the relationship between MHCs and 30-day readmissions. METHODS This retrospective, cross-sectional study of the 2013 Nationwide Readmissions Database included 512,997 hospitalizations of patients ages 3 to 21 years for the 10 medical and 10 procedure conditions with the highest number of 30-day readmissions. MHCs were identified by using the International Classification of Diseases, 9th Revision-Clinical Modification codes. We derived logistic regression models to measure the associations between MHC and 30-day, all-cause, unplanned readmissions, adjusting for demographic, clinical, and hospital characteristics. RESULTS An MHC was present in 17.5% of medical and 13.1% of procedure index hospitalizations. Readmission rates were 17.0% and 6.2% for medical and procedure hospitalizations, respectively. In the multivariable analysis, compared with hospitalizations with no MHC, hospitalizations with MHCs had higher odds of readmission for medical admissions (adjusted odds ratio [AOR], 1.23; 95% confidence interval [CI], 1.19-1.26] and procedure admissions (AOR, 1.24; 95% CI, 1.15-1.33). Three types of MHCs were associated with higher odds of readmission for both medical and procedure hospitalizations: depression (medical AOR, 1.57; 95% CI, 1.49-1.66; procedure AOR, 1.39; 95% CI, 1.17-1.65), substance abuse (medical AOR, 1.24; 95% CI, 1.18-1.30; procedure AOR, 1.26; 95% CI, 1.11-1.43), and multiple MHCs (medical AOR, 1.43; 95% CI, 1.37-1.50; procedure AOR, 1.26; 95% CI, 1.11-1.44). CONCLUSIONS MHCs are associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. Understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with cooccurring physical and mental health conditions.
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Affiliation(s)
- Stephanie K Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Lawlor
- Children's Hospital Association, Washington, DC and Lenexa, Kansas, USA
| | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California, USA
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Naomi S Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Kris P Rehm
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James C Gay
- Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Washington, DC and Lenexa, Kansas, USA
| | - Jay G Berry
- Department of Medicine, Division of General Pediatrics, Complex Care Service, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Improving adherence to asthma medications: current knowledge and future perspectives. Curr Opin Pulm Med 2018; 23:62-70. [PMID: 27755160 DOI: 10.1097/mcp.0000000000000334] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Poor adherence to asthma controller medications, particularly inhaled corticosteroids, has been well known for decades and is a major cause of uncontrolled asthma and increased healthcare utilization. This review presents recent evidence on factors leading to nonadherence in specific age groups, parents of young children, adolescents and young adults, adults, and the elderly. Novel management strategies including electronic sensors with associated smart phone applications for adherence improvement are discussed. RECENT FINDINGS Interventions to promote adherence must include a focus on issues important to the patient. Parents are concerned about adverse effects and the difficulty of medication administration in their child; adolescents and young adults need help with organizational skills and social barriers; adults may be more receptive to the need for daily medication after an acute exacerbation and acceptance of their disease; the elderly may have medication misuse issues associated with cognitive decline and other comorbidities related to aging. In all age groups, a trusting relationship with the provider is the key. New digital devices to track adherence may provide feedback to the patient and provider to evaluate and to promote adherence. SUMMARY Personalized approaches are required to address adherence barriers in target populations. Research on specific needs and barriers in target populations and development of appropriate strategies for use of new digital technology for adherence monitoring is needed.
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Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. PATIENT EDUCATION AND COUNSELING 2018; 101:687-695. [PMID: 29129307 PMCID: PMC5878979 DOI: 10.1016/j.pec.2017.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents. METHODS Fourty-two inner-city adolescents (ages 16-20) participated in a 12hour asthma self-management training program. Self-management knowledge, attitude toward asthma, and asthma-related self-efficacy were measured using short-answer tests before and after training. T-Tests were used to evaluate impact and effect sizes were calculated. RESULTS Mean pretest knowledge was 21.37/46 points; mean posttest was 36.33/46 points. Change from pre- to posttest was highly significant (t=10.34; p<0.0001), with a large effect size (d=1.68). Females improved more than males (18.66±8.58 vs. 12.29±8.13, p=0.039). Greatest effects were seen in awareness of long-term consequences of uncontrolled asthma (d=2.04), ability to recognize symptoms of life-threatening asthma (d=1.61), correctly monitor symptoms (d=1.49), and tell if asthma was uncontrolled (d=1.39). Asthma self-efficacy also improved significantly (p=0.017), particularly confidence in ability to correctly manage asthma, however improvements in attitude did not achieve statistical significance. CONCLUSION Developmentally appropriate training is effective in increasing critical self-management knowledge and self-efficacy in inner city adolescents, particularly females. PRACTICE IMPLICATIONS Providers should screen carefully for symptoms and educate using developmentally appropriate training materials on ways to correctly monitor and manage symptom.
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Affiliation(s)
- Jennifer R Mammen
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States.
| | - Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Shannska Atis
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Annette Grape
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
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McQuaid EL. Barriers to medication adherence in asthma: The importance of culture and context. Ann Allergy Asthma Immunol 2018; 121:37-42. [PMID: 29580846 DOI: 10.1016/j.anai.2018.03.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention. DATA SOURCES Data were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials. STUDY SELECTIONS Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity. RESULTS There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of complementary and alternative medicine use, difficulties communicating with patients and caregivers with limited English proficiency, and implicit biases regarding cultural differences. Systems issues (eg, insurance status, cost) and social context factors (eg, exposure to violence) also present challenges. Culturally informed strategies that capitalize on patient strengths and training providers in culturally informed communication strategies hold promise as intervention approaches. CONCLUSION Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
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Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island.
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Arnold CM, Bixenstine PJ, Cheng TL, Tschudy MM. Concordance among children, caregivers, and clinicians on barriers to controller medication use. J Asthma 2018; 55:1352-1361. [PMID: 29420091 DOI: 10.1080/02770903.2018.1424188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. METHODS We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. RESULTS Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. CONCLUSIONS There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.
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Affiliation(s)
- Carolyn M Arnold
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Paul J Bixenstine
- b Departments of Pediatrics & Internal Medicine , University of California Los Angeles School of Medicine , Los Angeles , CA , USA
| | - Tina L Cheng
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Megan M Tschudy
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Teufel II 2nd RJ, Patel SK, Shuler AB, Andrews AL, Nichols M, Ebeling MD, Dawley E, Mueller M, Ruggiero KJ, Treiber FA. Feasibility of Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High Risk Youth and Adolescents with Asthma: A Pilot Study (Preprint). JMIR Mhealth Uhealth 2018. [DOI: 10.2196/mhealth.9796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rhee H, Wicks MN, Dolgoff JS, Love TM, Harrington D. Cognitive factors predict medication adherence and asthma control in urban adolescents with asthma. Patient Prefer Adherence 2018; 12:929-937. [PMID: 29872278 PMCID: PMC5973469 DOI: 10.2147/ppa.s162925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Adolescents with asthma often report poor medication adherence and asthma control. Cognitive factors embedded in the social cognitive theory including self-efficacy, outcome expectations, and barrier perceptions may explain poor asthma outcomes in this population. This study was performed to examine the extent to which these cognitive factors are intercorrelated and explain medication adherence and asthma control in urban adolescents. PATIENTS AND METHODS A total of 373 urban adolescents (12-20 years) with asthma completed questionnaires measuring asthma-related self-efficacy, outcome expectations, barrier perceptions, medication adherence, and asthma control. Multiple linear regression was conducted to examine the extent to which the three cognitive factors predicted medication adherence and asthma control after controlling for covariates including age, sex, household income, and age at diagnosis. RESULTS Participants' ages were on average 14.68 (±1.94) years; 50% were female, and most (78.6%) were African American. Higher self-efficacy associated with lower barrier perceptions and higher outcome expectations (r=0.50, p<0.001; r=-0.26, p<0.001, respectively). Self-efficacy predicted better asthma control (B=-0.098, p=0.004) and adherence (B=0.426, p=0.011), whereas barrier perceptions predicted poorer asthma control (B=0.13, p<0.001) and adherence (B=-0.568, p<0.001). Self-efficacy independently predicted fewer missed doses (B=-0.621, p=0.006), and barrier perception independently predicted asthma control (B=0.12, p<0.001) and adherence (B=-0.519, p<0.001). CONCLUSION Improving medication adherence and asthma control among adolescents may require a multifaceted approach. Interventions focused on increasing self-efficacy and addressing barriers, actual or potential, to medication adherence could ameliorate asthma disparities in urban adolescents.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester School of Nursing, Rochester, NY, USA
- Correspondence: Hyekyun Rhee, University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642, USA, Tel +1 585 276 3775, Fax +1 585 273 1270, Email
| | - Mona N Wicks
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer S Dolgoff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tanzy M Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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Anders J, Hill A, Chung SE, Butz A, Rothman R, Gaydos C, Perin J, Trent M. Patient Satisfaction and Treatment Adherence for Urban Adolescents and Young Adults with Pelvic Inflammatory Disease. ACTA ACUST UNITED AC 2017; 3. [PMID: 29756068 DOI: 10.15761/tec.1000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives Urban adolescents with pelvic inflammatory disease (PID) often seek care in emergency departments (ED). This study examines the effect of the ED patient experience - wait time (WT) and length of stay (LOS) - on satisfaction and medication adherence among urban adolescents with PID. Methods Adolescents with PID were enrolled in an urban teaching hospital ED. Chart data were matched with 2-week interview queries about satisfaction and medication adherence. Chi-square and logistic regression analyses evaluated the relationships between WT, LOS, provider type, satisfaction, and medication adherence. Results Of 83 participants, 96% report satisfaction with care, but only 45% report medication adherence. Mean WT was 55 minutes and mean LOS 200 minutes. Patients with higher LOS were less adherent with medication; this relationship became non-significant after adjustments. Patients seen by trainees had much longer LOS, but no differences in satisfaction or medication adherence. Conclusions Urban adolescents with PID report satisfaction with ED care despite prolonged LOS and medication adherence is poor. Optimization of ED workflows may improve outcomes in young women with PID.
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Affiliation(s)
- Jennifer Anders
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra Hill
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shang-En Chung
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Butz
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Johns Hopkins University School of Public Health, Baltimore Maryland
| | - Maria Trent
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Fu N, Jacobson K, Round A, Evans K, Qian H, Bressler B. Transition clinic attendance is associated with improved beliefs and attitudes toward medicine in patients with inflammatory bowel disease. World J Gastroenterol 2017; 23:5405-5411. [PMID: 28839441 PMCID: PMC5550790 DOI: 10.3748/wjg.v23.i29.5405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/07/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluated the differences in knowledge, adherence, attitudes, and beliefs about medicine in adolescents with inflammatory bowel disease (IBD) attending transition clinics.
METHODS We prospectively enrolled patients from July 2012 to June 2013. All adolescents who attended a tertiary-centre-based dedicated IBD transition clinic were invited to participate. Adolescent controls were recruited from university-affiliated gastroenterology offices. Participants completed questionnaires about their disease and reported adherence to prescribed therapy. Beliefs in Medicine Questionnaire was used to evaluate patients’ attitudes and beliefs. Beliefs of medication overuse, harm, necessity and concerns were rated on a Likert scale. Based on necessity and concern ratings, attitudes were then characterized as accepting, ambivalent, skeptical and indifferent.
RESULTS One hundred and twelve adolescents were included and 59 attended transition clinics. Self-reported adherence rates were poor, with only 67.4% and 56.8% of patients on any IBD medication were adherent in the transition and control groups, respectively. Adolescents in the transition cohort held significantly stronger beliefs that medications were necessary (P = 0.0035). Approximately 20% of adolescents in both cohorts had accepting attitudes toward their prescribed medicine. However, compared to the control group, adolescents in the transition cohort were less skeptical of (6.8% vs 20.8%) and more ambivalent (61% vs 34%) (OR = 0.15; 95%CI: 0.03-0.75; P = 0.02) to treatment.
CONCLUSION Attendance at dedicated transition clinics was associated with differences in attitudes in adolescents with IBD.
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Ayele Y, Engidawork E, Bayisa T. Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia. BMC Res Notes 2017; 10:314. [PMID: 28743293 PMCID: PMC5526241 DOI: 10.1186/s13104-017-2645-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use. Methods A cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables. Results Overall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors. Conclusion In this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2645-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tola Bayisa
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Nabors L, Odar-Stough C, Peugh J, Merianos AL, Cunningham J, Yockey RA. Adolescent flourishing in relation to having asthma: Results from a population-based cross-sectional study. J Asthma 2017; 55:132-136. [PMID: 28471696 DOI: 10.1080/02770903.2017.1316390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study investigated parent report of adolescent behaviors and flourishing of adolescents with asthma from a nationwide sample. METHODS A secondary analysis of the 2011-2012 National Survey of Children's Health was conducted. There were 2,880 youth with asthma in our sample and 25,841 without asthma between 13 and 17 years of age. Analyses examined flourishing among adolescents with and without asthma and the impact of adolescent arguing, bullying, and mood difficulties on adolescent flourishing for adolescents with asthma, while controlling for sex, age, and race. RESULTS Findings indicated lower flourishing for youth with asthma compared to youth without asthma. Moreover, adolescents with asthma who experienced negative behaviors, such as arguing and bullying, and adolescents who were experiencing sad feelings had lower flourishing. CONCLUSIONS The results were consistent with literature, indicating that relatively poorer behavioral and emotional functioning is related to lower flourishing in adolescents with asthma. The results highlight the importance of screening for emotional functioning in adolescents and the need for further research to understand characteristics of adolescents related to their positive functioning.
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Affiliation(s)
- Laura Nabors
- a Health Promotion and Education Program, School of Human Services, College of Education Criminal Justice and Human Services , University of Cincinnati , Cincinnati , Ohio , USA
| | - Cathleen Odar-Stough
- b Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,c Department of Psychology, College of Arts and Sciences , University of Cincinnati , Cincinnati , Ohio , USA
| | - James Peugh
- b Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
| | - Ashley L Merianos
- a Health Promotion and Education Program, School of Human Services, College of Education Criminal Justice and Human Services , University of Cincinnati , Cincinnati , Ohio , USA
| | - Jodi Cunningham
- a Health Promotion and Education Program, School of Human Services, College of Education Criminal Justice and Human Services , University of Cincinnati , Cincinnati , Ohio , USA
| | - Robert Andrew Yockey
- c Department of Psychology, College of Arts and Sciences , University of Cincinnati , Cincinnati , Ohio , USA
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Mammen JR, Rhee H, Norton SA, Butz AM. Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma. J Asthma 2017; 54:143-152. [PMID: 27337035 PMCID: PMC5182183 DOI: 10.1080/02770903.2016.1201835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. OBJECTIVES To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. METHODS A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. RESULTS Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. CONCLUSIONS Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.
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Affiliation(s)
| | - Hyekyun Rhee
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Sally A Norton
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Arlene M Butz
- b Johns Hopkins University, School of Medicine , Baltimore , MD , USA
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Application of Human Augmentics: A Persuasive Asthma Inhaler. J Biomed Inform 2017; 67:51-58. [PMID: 28193465 DOI: 10.1016/j.jbi.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 11/20/2022]
Abstract
This article describes a tailored health intervention delivered on a mobile phone platform, integrating low-literacy design strategies and basic principles of behavior change, to promote increased adherence and asthma control among underserved minority adolescents. We based the intervention and design principles on theories of Human Augmentics and the Elaboration Likelihood Model. We tested the efficacy of using electronic monitoring devices that incorporate informative and persuasive elements to improve adherence to a prescribed daily medication regimen intended to reduce use of asthma rescue medications. We describe the theoretical framework, hardware and software systems, and results of user testing for design purposes and a clinical pilot study incorporating use of the device and software by the targeted population. The results of the clinical pilot study showed an 83% completion rate for the treatment as well as improved adherence. Of note, 8% and 58% of participants achieved clinically significant adherence targets at baseline and last week of the study, respectively. Rescue asthma medication use decreased from a median of 3 puffs per week at baseline to 0 puffs per week during the last week of the study.
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Dońka K, Czarnocki KJ, Emeryk A. Validation of the Polish version of Satisfaction with Asthma Treatment Questionnaire (SATQ). Postepy Dermatol Alergol 2017; 34:77-81. [PMID: 28261035 PMCID: PMC5329109 DOI: 10.5114/ada.2017.65625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/27/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Among the chronically ill there is a tendency for non-compliance with medical recommendations, which is often due to low satisfaction with the offered treatment. Satisfaction with Asthma Treatment Questionnaire (SATQ) is a questionnaire for measuring satisfaction with the inhalation treatment of asthma in patients of more than 18 years of age. SATQ is a standardized tool that has not been previously used in Poland. SATQ consists of 4 domains: efficiency, ease of use, the burdening with asthma treatment and side effects and concerns. AIM To validate the Polish language version of SATQ questionnaire and an overall verification of the usefulness of the tool relative to trials from clinical practice. MATERIAL AND METHODS The degree of difficulty and comprehension of the questions and the reliability and validity of the Polish version of the questionnaire was determined in 67 patients with asthma (mean age: 45.8 ±14.3 years (range maximum - at least 18-65 years). The vast majority of patients in the study group have used the inhalers for more than 1 year and were educated in the field of aerosols management. The resulting scores are calculated by adding up the scores for each question and dividing by the number of questions. The reliability of the questionnaire design was verified using the Spearman rank correlation coefficients between elements and ranges between band assessments and evaluations and overall assessment of quality and patient satisfaction with treatment. Internal consistency and reliability of the tool was assessed using Cronbach's α. The values of Cronbach's α were evaluated with respect to the threshold value of 0.70. RESULTS SATQ questionnaire was understandable and easy to fill out for all subjects. The filling time of SATQ was designed as to be within 5-10 min. Cronbach's α was reached on all scales, demonstrating the reliability of the analyzed scale and lack of redundancy. CONCLUSIONS The Polish version of SATQ questionnaire meets the basic psychometric criteria and can be used to assess satisfaction with the inhalation treatment of asthma.
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Affiliation(s)
- Katarzyna Dońka
- Chair and Department of Pediatric Nursing, Medical University of Lublin, Lublin, Poland
| | | | - Andrzej Emeryk
- Chair of Lung Diseases and Rheumatology, Medical University of Lublin, Lublin, Poland
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Li Z, Leite WL, Thompson LA, Gross HE, Shenkman EA, Reeve BB, DeWalt DA, Huang IC. Determinants of longitudinal health-related quality-of-life change in children with asthma from low-income families: a report from the PROMIS ® Pediatric Asthma Study. Clin Exp Allergy 2016; 47:383-394. [PMID: 27664979 DOI: 10.1111/cea.12827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND How the longitudinal asthma control status and other socio-demographic factors influence the changes of health-related quality of life (HRQOL) among asthmatic children, especially from low-income families, has not been fully investigated. OBJECTIVES This study aimed to describe the trajectories of asthma-specific HRQOL over 15 months and examine the effect of asthma control status on HRQOL by taking socio-demographic factors into consideration. METHODS A total of 229 dyads of asthmatic children and their parents enroled in public insurance programs were recruited for assessing asthma control status and HRQOL over four time points of assessment. Asthma control status was measured using the Asthma Control and Communication Instrument, and asthma-specific HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System's Pediatric Asthma Impact Scale. Latent growth models (LGMs) were applied to examine the trajectory of HRQOL and the factors contributing to the changes of HRQOL. RESULTS Unconditional LGM revealed that HRQOL was improved over time. Conditional LGM suggested that accounting for asthma control and participants' socio-demographic factors, the variation in the initial level of HRQOL was significant, yet the rate of change was not. Conditional LGM also revealed that poorly controlled asthma status was associated with poor HRQOL at each time point (P's < 0.05). Lower parental education was associated with lower baseline HRQOL (P < 0.05). Hispanic children had a larger increase in HRQOL over time (P < 0.01) than non-Hispanic White children. CONCLUSIONS Vulnerable socio-demographic characteristics and poorly controlled asthma status affect HRQOL in children. This finding encourages interventions to improve asthma control status and HRQOL in minority children.
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Affiliation(s)
- Z Li
- College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN, USA
| | - W L Leite
- School of Human Development and Organizational Studies in Education, College of Education, University of Florida, Gainesville, FL, USA
| | - L A Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - H E Gross
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - B B Reeve
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D A DeWalt
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - I-C Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, SOH JY, Le Souef P. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J 2016; 9:26. [PMID: 27551328 PMCID: PMC4982274 DOI: 10.1186/s40413-016-0117-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023] Open
Abstract
Despite the availability of several formulations of inhaled corticosteroids (ICS) and delivery devices for treatment of childhood asthma and despite the development of evidence-based guidelines, childhood asthma control remains suboptimal. Improving uptake of asthma management plans, both by families and practitioners, is needed. Adherence to daily ICS therapy is a key determinant of asthma control and this mandates that asthma education follow a repetitive pattern and involve literal explanation and physical demonstration of the optimal use of inhaler devices. The potential adverse effects of ICS need to be weighed against the benefit of these drugs to control persistent asthma especially that its safety profile is markedly better than oral glucocorticoids. This article reviews the key mechanisms of inhaled corticosteroid action; recommendations on dosage and therapeutic regimens; potential optimization of effectiveness by addressing inhaler technique and adherence to therapy; and updated knowledge on the real magnitude of adverse events.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | | | - Bee Wah Lee
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Meenu Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dalia El-Ghoneimy
- Pediatric Allergy and Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, 11566 Egypt
| | - Jian Yi SOH
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter Le Souef
- Winthrop Professor of Paediatrics & Child Health, School of Paediatrics & Child Health, University of Western Australia, Crawley, Australia
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Ahmad A, Sorensen K. Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. J Asthma 2016; 53:862-78. [PMID: 27053332 DOI: 10.3109/02770903.2016.1155217] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this systematic literature review is to study the enabling and hindering factors influencing adherence to asthma treatment among adolescents. Furthermore, it explores the role of caregivers and the healthcare provider in terms of supporting adolescents to manage and live with asthma. DATA SOURCES The literature review was conducted using the MeSH terms asthma, adherence, health literacy, behavior, adolescents, tools, healthcare provider, caregiver, peer influence, self-management, quality of life, morbidity and mortality in PubMed, PsycInfo, MEDLINE and CINAHL. STUDY SELECTION The literature search resulted in 652 articles of which 304 were screened based on title and abstracts. Ninety-one of the screened articles were then selected for full-text assessment resulting in 42 articles for in-depth analysis. RESULTS The literature review identified nine enabling and hindering factors relevant for adherence to asthma treatment among adolescents: behavior, belief, self-management, health literacy, role of health provider, assessment of adherence, role of caregiver, role of peers and the national asthma guidelines. CONCLUSION Working with this particular age group is complex and further research in understanding adolescent's behavior, motives, beliefs and perceptions towards adherence to asthma treatment is required to guide them towards better self-management and acceptance of their condition.
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Affiliation(s)
- Anam Ahmad
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
| | - Kristine Sorensen
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
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Yang HJ. Clinicoepidemiological research designs in childhood allergic diseases. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Tiggelman D, van de Ven MOM, van Schayck OCP, Engels RCME. Longitudinal associations between asthma control, medication adherence, and quality of life among adolescents: results from a cross-lagged analysis. Qual Life Res 2015; 24:2067-74. [PMID: 25715944 DOI: 10.1007/s11136-015-0945-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE It is not completely clear whether and how medication adherence, asthma control, and quality of life (QOL) predict each other over time. Therefore, the aim of the present study was to examine the longitudinal associations between asthma control, medication adherence, and quality of life among adolescents. METHODS In this 3-wave longitudinal study, adolescents (N = 139, Mean age = 11.8) completed questionnaires about their medication adherence (Medication Adherence Report Scale for Asthma), asthma control (Asthma Control Questionnaire), and QOL (Adolescent Asthma Quality of Life Questionnaire) during home visits in the spring/summer of 2011, 2012, and 2013. Cross-lagged analyses examined temporal interrelations between the three variables over the course of 3 years. RESULTS Higher QOL at baseline predicted increased medication adherence at follow-up (T2), but did not predict changes in asthma control over time. Medication adherence and asthma control did not predict changes in QOL over time. There were no associations between asthma control and medication adherence over time. CONCLUSIONS Interventions could focus on increasing QOL to increase medication adherence in adolescents with asthma.
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Affiliation(s)
- Dana Tiggelman
- Behavioural Science Institute (BSI), Faculty of Social Sciences, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands,
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Miadich SA, Everhart RS, Borschuk AP, Winter MA, Fiese BH. Quality of Life in Children With Asthma: A Developmental Perspective. J Pediatr Psychol 2015; 40:672-9. [PMID: 25680363 DOI: 10.1093/jpepsy/jsv002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/07/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The current study investigated whether factors associated with quality of life (QOL) in children with asthma (e.g., family functioning, asthma routines, asthma severity) differed by child age. METHODS Participants included 192 children with asthma (5-12 years) and their caregivers. Both children and caregivers completed questionnaires at an initial research session. Family functioning was determined from a mealtime observation that occurred in family homes. RESULTS Child age moderated the association between asthma severity and child QOL and between routine burden and QOL in children with asthma. Post hoc probing analyses revealed that among older children, QOL levels were lower in the presence of worse asthma severity and more routine burden. CONCLUSIONS Findings suggest that associations between asthma severity, routine burden, and QOL may differ by child age. Treatment programs and health-care recommendations addressing QOL in children with asthma may need to be tailored to address differences in factors associated with QOL by child age.
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Affiliation(s)
| | | | | | - Marcia A Winter
- Department of Psychology, Virginia Commonwealth University and
| | - Barbara H Fiese
- Department of Human and Community Development, University of Illinois at Urbana-Champaign
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