title: Inhaled corticosteroid beliefs, complementary and alternative medicine, and uncontrolled asthma in urban minority adults.
abstract: BACKGROUND
  Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults.
  
  
  OBJECTIVE
  This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care.
  
  
  METHODS
  Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility.
  
  
  RESULTS
  Psychometric testing of the instrument identified 17 items representing ICS beliefs (α = .59) and CAM endorsement (α = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients.
  
  
  CONCLUSIONS
  Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa. Electronic address: mgeorge@nursing.upenn.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: George
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pa; University of Haifa, Haifa, Israel.
authors.forename: Maxim
authors.initials: M
authors.lastname: Topaz
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, Pa.
authors.forename: Marilyn Lynn Sawyer
authors.initials: MLS
authors.lastname: Sommers
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.affiliation: Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Pantalon
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000523:psychology* / Q000628:therapy*; D001294:Attitude to Health; D000529:Complementary Therapies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008913:Minority Groups; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Asthma; adherence; beliefs; black; complementary and alternative medicine; inhaled corticosteroids; instrument development; minority; mixed methods; patient-provider communication; self-management; urban