title: Patterns of concordance and non-concordance with clinician recommendations and parents' explanatory models in children with asthma.
abstract: OBJECTIVE
  Many children with asthma do not take medications as prescribed. We studied parents of children with asthma to define patterns of non-concordance between families' use of asthma controller medications and clinicians' recommendations, examine parents' explanatory models (EMs) of asthma, and describe relationships between patterns of non-concordance and EM.
  
  
  METHODS
  Qualitative study using semi-structured interviews with parents of children with persistent asthma. Grounded theory analysis identified recurrent themes and relationships between reported medication use, EMs, and other factors.
  
  
  RESULTS
  Twelve of the 37 parents reported non-concordance with providers' recommendations. Three types of non-concordance were identified: unintentional--parents believed they were following recommendations; unplanned--parents reported intending to give controller medications but could not; and intentional--parents stated giving medication was the wrong course of action. Analysis revealed two EMs of asthma: chronic--parents believed their child always has asthma; and intermittent--parents believed asthma was a problem their child sometimes developed.
  
  
  CONCLUSIONS
  Concordance or non-concordance with recommended use of medications were related to EM's and family context and took on three different patterns associated with medication underuse.
  
  
  CONCLUSIONS
  Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Affairs Medical Center,Bedford, MA 01742, United States. bokhour@bu.edu
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Cohn
authors.forename: Dharma E
authors.initials: DE
authors.lastname: Cortés
authors.forename: Leanne S
authors.initials: LS
authors.lastname: Yinusa-Nyahkoon
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hook
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Smith
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D001249:Asthma / Q000188:drug therapy / Q000209:etiology; D001900:Boston; D015984:Causality; D002648:Child; D002675:Child, Preschool; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008508:Medication Errors / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008960:Models, Psychological; D015404:Nursing Methodology Research; D010290:Parents / Q000193:education / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012646:Self Administration / Q000379:methods / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires