Barriers to anti-inflammatory medication use in childhood asthma.
OBJECTIVE
To identify parental barriers to anti-inflammatory medication use and to develop an instrument for use in research and health care settings to identify at-risk populations.


METHODS
Instrument development consisted of 4 phases: 1) gaining the professional perspective (N = 8 experts in asthma management), 2) gaining the perspective of parents of children with asthma (qualitative interviews with 21 parents), 3) instrument pretesting and refinement (N = 133 parents), and 4) determining the instrument's psychometric properties. Study participants were diverse in race, socioeconomic status, and the child's illness severity. The final instrument consisted of 51 questions in 5 domains (nature of disease, cause, ideas about medications, treatment expectations, and health care provider relationship).


RESULTS
The final instrument exhibited strong reliability (Cronbach alpha =.87) and validity. Significant barriers to appropriate anti-inflammatory medication use were parents' diminished treatment expectations and fears about anti-inflammatory medications. Minority families were more likely than white families to view asthma as unpredictable and uncontrollable (P =.01) and to have negative attitudes toward anti-inflammatory medications (P =.004). Eight questions were significantly correlated with a suboptimal medication regimen and may serve as a "quick screen" for potential nonadherence in clinical settings.


CONCLUSIONS
Diminished treatment expectations and negative attitudes toward anti-inflammatories may be powerful predictors of nonadherence to medications.
Yoos
H Lorrie
HL
University of Rochester Medical Center, Department of Pediatrics, and the University of Rochester School of Nursing, Rochester, NY 14642, USA. lorrie_yoos@urmc.rochester.edu
Kitzman
Harriet
H
McMullen
Ann
A
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000193:education / Q000523:psychology; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008297:Male; D009518:New York; D010290:Parents / Q000193:education* / Q000523:psychology*; D011594:Psychometrics; D036301:Qualitative Research; D012307:Risk Factors; D012959:Socioeconomic Factors; D013256:Steroids; D011795:Surveys and Questionnaires / Q000592:standards*; D044465:White People / Q000193:education / Q000523:psychology
D000893:Anti-Inflammatory Agents; D013256:Steroids