Qualitative research-enhanced understanding of patients' beliefs: results of focus groups with low-income, urban, African American adults with asthma.
BACKGROUND
Qualitative research is an important research methodology for understanding the health beliefs and attitudes of patients. These beliefs and attitudes have been proposed as partial explanations for low adherence to medical therapy and the consequent high burden of morbidity from asthma among low-income urban minorities.


OBJECTIVE
The purpose of this study was to explore barriers to adherence to inhaled corticosteroids (ICSs), health beliefs regarding asthma and its treatment, and opinions about providers and clinical research among low-income groups.


METHODS
Three focus groups were conducted with 15 low-income, urban, African American adults with persistent asthma. These focus group sessions were audiotaped, transcribed verbatim, and coded by using qualitative analytic techniques.


RESULTS
Health beliefs that influenced adherence included patients' reliance on their assessment of asthma control over that of the health provider and concern over the adverse effects of ICS therapy. Adherence was also adversely affected by social obligations and insurers' approval policies and restricted formularies. Although mistrust of the medical establishment was evident, members generally expressed a willingness to participate in nonpharmacologic clinical research and the belief that research was beneficial. However, they had strong preferences for where the research should be conducted.


CONCLUSIONS
Although barriers exist to ICS adherence in patient populations, many of these can be addressed during patient-clinician interactions. Qualitative research is an important tool for formulating hypotheses for improving ICS adherence that can then be tested in the future by using quantitative research methods.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, PA 19104, USA.
Maureen
M
George
Tovia G
TG
Freedman
A Lorraine
AL
Norfleet
Harold I
HI
Feldman
Andrea J
AJ
Apter
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology* / Q000523:psychology; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D036301:Qualitative Research; D014505:Urban Population
D000305:Adrenal Cortex Hormones