The impact of the parental illness representation on disease management in childhood asthma.
BACKGROUND
Despite significant advances in treatment modalities, morbidity due to childhood asthma has continued to increase, particularly for poor and minority children.


OBJECTIVE
To describe the parental illness representation of asthma in juxtaposition to the professional model of asthma and to evaluate the impact of that illness representation on the adequacy of the child's medication regimen.


METHODS
Parents (n = 228) of children with asthma were interviewed regarding illness beliefs using a semistructured interview. The impact of background characteristics, parental beliefs, the child's symptom interpretation, and the parent-healthcare provider (HCP) relationship on the adequacy of the child's medication regimen were evaluated.


RESULTS
The parental and professional models of asthma differ markedly. Demographic risk factors (p = .005), low parental education (p < .0001), inaccurate symptom evaluation by the child (p = .02), and a poor parent-HCP relationship (p < .0001) had a negative effect on the parental illness representation. A parental illness representation concordant with the professional model of asthma (p = .05) and more formal asthma education (p = .02) had a direct positive effect on the medication regimen. Demographic risk factors (p = .006) and informal advice-seeking (p = .0003) had a negative impact on the regimen. The parental illness representation mediated the impact of demographic risk factors (p = .10), parental education (p =.07), and the parent-HCP relationship (p = .06) on the regimen.


CONCLUSIONS
Parents and HCPs may come to the clinical encounter with markedly different illness representations. Establishing a partnership with parents by eliciting and acknowledging parental beliefs is an important component of improving disease management.
Yoos
H Lorrie
HL
University of Rochester School of Nursing, University of Rochester School of Medicine and Dentistry, New York, USA. lorrie_yoos@urmc.rochester.edu
Kitzman
Harriet
H
Henderson
Charles
C
McMullen
Ann
A
Sidora-Arcoleo
Kimberly
K
Halterman
Jill S
JS
Anson
Elizabeth
E
D001249:Asthma / Q000517:prevention & control*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019468:Disease Management; D004522:Educational Status; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016018:Least-Squares Analysis; D008960:Models, Psychological; D009341:Negativism; D009518:New York; D015404:Nursing Methodology Research; D010290:Parents / Q000193:education / Q000523:psychology*; D011203:Poverty / Q000523:psychology; D011368:Professional-Family Relations; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires