Conn KM, Halterman JS, Lynch K, Cabana MD. Pediatrics. 2007;120(3). Available at: www.pediatrics.org/cgi/content/full/120/3/e521
PURPOSE OF THE STUDY. To evaluate how parents’ beliefs about asthma medications can influence their adherence to their child's prescribed therapy and assess whether race/ethnicity is an independent predictor of medication adherence.
STUDY POPULATION. The authors conducted a cross-sectional survey of parents of children with asthma in southeast Michigan who were on ≥1 preventive asthma medication between April 2004 and February 2005. Parents (n = 1858) were selected from rural, suburban, and urban areas from 40 primary care pediatric offices, of which 1322 agreed to participate in the telephone survey (response rate: 71.2%). There were 622 patients who completed the survey and met the study criteria.
METHODS. To assess parents’ positive and negative attitudes about their child's medications, a previously validated 10-item Beliefs About Medications Questionnaire was used. A necessity-concern differential score was calculated and separated the study population into 3 groups: greater concern than necessity; equal to concern; and greater necessity than concern. To measure medication adherence, a 4-item parent-report scale Medication Adherence Score was used.
RESULTS. Only 14% of the parents reported full compliance with their child's medications. Among 77% of the parents, necessity scores outweighed concern scores. For 17%, concerns outweighed necessity, and 6% had equal scores. Nonminority parents were more likely to have necessity scores that exceeded concern scores (79% vs 68%; P = .03). Other factors associated with parents having a higher concern than need score were parents who used alternative therapies (P = .03), parents whose children were taking <2 preventive medications (P = .01), and parents who rated their child's last exacerbation as moderate to severe. Mean adherence scores increased as the necessity-concern differential score increased.
CONCLUSIONS. When parents’ positive and negative beliefs about medications are weighed against each other, most felt greater need for their child's medications than concern, and this was independently associated with better adherence scores. Nonminority status was independently linked with better medication adherence scores.
REVIEWER COMMENTS. The question that was not answered with this study is whether physician-directed patient education regarding asthma and asthma medications affects parents’ beliefs and subsequent adherence to their child's asthma medications. It would be interesting to explore the basis for parental concern, addressing the concerns and reinforcing the perception of need through education, and then measure the impact of the intervention on change in adherence.
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