title: Adherence to asthma medication regimens in urban African American adolescents: application of self-determination theory.
abstract: OBJECTIVE
  Asthma medication adherence is low, particularly among African American adolescents, a high-risk group with respect to asthma prevalence, morbidity, and mortality. This study tested the utility of self-determination theory (SDT), a theory of motivation, to explain adherence to asthma medication regimens in African American adolescents.
  
  
  METHODS
  We used baseline data from 168 urban African American adolescents (Mage = 13.94 years; 61% male) with poorly controlled asthma who were part of a trial testing the efficacy of interventions to improve adherence. Participants and their caregivers were interviewed using the Family Asthma Management System Scale; this study used the Asthma Medication Adherence subscale. Adolescents completed four asthma-specific scales representing the SDT constructs of autonomous motivation (one importance scale), competence (one confidence scale), and relatedness (two scales--family routines and parental support). Using multiple linear regression, we tested the hypothesis that SDT variables would predict adherence.
  
  
  RESULTS
  Adherence was significantly correlated with three SDT variables--importance, confidence, and family routines. In multivariate analysis, family routines was the only significant predictor of asthma adherence (p < .001). Asthma management behaviors integrated into and shared among family members was associated with better adherence. Greater confidence was marginally associated with increased adherence (p = .07).
  
  
  CONCLUSIONS
  Though several variables representing SDT constructs were correlated with adherence, results demonstrate that family routines may be more relevant for African American adolescents' adherence than other SDT constructs. Thus, helping families to share and better integrate asthma care into daily schedules may be an important intervention strategy to improve medication adherence among high-risk African American adolescents.
authors.affiliation: NYU Child Study Center, Department of Child and Adolescent Psychiatry, NYU School of Medicine.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bruzzese
authors.affiliation: Department of Pediatrics, Wayne State University.
authors.forename: April
authors.initials: A
authors.lastname: Idalski Carcone
authors.affiliation: Department of Pediatrics, Wayne State University.
authors.forename: Phebe
authors.initials: P
authors.lastname: Lam
authors.affiliation: Department of Pediatrics, Wayne State University.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Ellis
authors.affiliation: Department of Pediatrics, Wayne State University.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naar-King
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology* / Q000523:psychology; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology; D009042:Motivation; D026684:Personal Autonomy; D011582:Psychological Theory; D036301:Qualitative Research; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D018927:Anti-Asthmatic Agents