Compliance of adolescents with asthma

Compliance challenges in a longitudinal COVID-19 cohort using wearables for continuous monitoring

BACKGROUND

Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19 (WEAICOR) study is a prospective observational study using continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results.

OBJECTIVE

The aim of this study is to evaluate patients' compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort.

METHODS

Biostrap wearable device was used to monitor participants' biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days in the study. Univariate correlation was performed between compliance, days in the study and age, BMI, sex, symptom severity, and number of complications/comorbidites as independent variables. Also, multivariate linear regression was then performed with days in the study as a dependent variable to assess the power of different parameters in determining days in the study.

RESULTS

On hundred twenty-two patients were included in the study. Patients were on average 43 years old and 32% were female. Age was found to be correlated with compliance (r=0.23, P=0.01). In addition, age (r=0.30, P=0.001), BMI (r=0.19, P=0.03) and severity of symptoms (r=0.19, P=0.03) were found to be correlated with days spent in the study. On multivariate analysis with days spent in the study as a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2 = 0.1, β = 1.6, P= 0.01).

CONCLUSIONS

Compliance is a major obstacle in remote monitoring studies and the reasons for a lack thereof are multifactorial. Patient factors such as age, in addition to environmental factors can affect compliance to wearables.

Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study

This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.

[Therapeutic adherence among asthma patients: Variations according to age groups. How can it be improved? The potential contributions of new technologies]

While asthma patients' treatment adherence (TA) generally leaves to be desired, few data exist on TA evolution from age group to another. During the meeting of a working group of pneumo-pediatricians and adult pulmonologists, we reviewed the literature on adherence according to age group, examined explanations for poor adherence, and explored ways of improving adherence via new technologies. Asthma is a chronic disease for which TA is particularly low, especially during adolescence, but also among adults. Inhaled medications are the least effectively taken. Several explanations have been put forward: cost and complexity of treatments, difficulties using inhalation devices, poor understanding of their benefits, erroneous beliefs and underestimation of the severity of a fluctuating disease, fear of side effects, neglect, and denial (especially among teenagers). Poor TA is associated with risks of needless treatment escalation, aggravated asthma with frequent exacerbations, increased school absenteeism, degraded quality of life, and excessive mortality. Better compliance is based on satisfactory relationships between caregivers and asthmatics, improved caregiver training, and more efficient transmission to patients of relevant information. The recent evolution of innovative digital technologies opens the way for enhanced communication, via networks and dedicated applications, and thanks to connected inhalation devices, forgetfulness can be limited. Clinical research will also help to ameliorate TA. Lastly, it bears mentioning that analysis of the existing literature is hampered by differences in terms of working definitions and means of TA measurement.

New approach to intermittent and mild asthma therapy: evolution or revolution in the GINA guidelines?

New recommendations from the Global Initiative for Asthma (GINA) were released in a pocket guide form on April 12, 2019. These recommendations provide very important changes to the management of asthma, especially regarding the treatment of intermittent and mild asthma. Due to safety concerns, GINA experts no longer recommend treatment with a short-acting β2 agonist alone. Henceforth, all adults and adolescents (but not yet children) with mild asthma should receive either symptom-driven or daily low-dose ICS. The main goal of this new approach is to reduce the risk of serious asthma exacerbations and asthma-related deaths in the population of patients with mild asthma. Herein, the authors present the epidemiological and clinical data regarding the risks of excessive SABA use and the benefits of regular treatment with inhaled corticosteroids. The authors deliver a critical review on the evolution of the changes in the GINA experts’ standpoint and provide evidence-based background for the new approach to asthma treatment. Moreover, the authors identify gaps and unmet needs still present in the current asthma management recommendations and discuss them thoroughly.

Patient decision-making in severe inflammatory bowel disease: the need for improved communication of treatment options and preferences

AIM

Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease.

METHODS

We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making.

RESULTS

Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions.

CONCLUSION

Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.

Effects of maintaining web-based diaries by caregivers on adherence to care regimens in preschoolers with asthma

BACKGROUND

The objective of this pilot study was to assess the effects of maintaining web-based diaries by the caregivers of preschoolers with asthma on the adherence to asthma care regimens, the recognition of asthma symptoms, and their perceived levels of parenting stress, quality of life, and family functioning.

DESIGN AND METHODS

The caregivers of preschoolers with asthma completed a 4-week web-based diary and received weekly emails that depicted their children's asthma symptoms. We compared asthma symptoms from before and after the intervention. We analyzed demographic data, such as the caregivers' age and education, and assessment scores from the Japanese Pediatric Asthma Control program (JPAC), Adherence with Asthma Management for Caregivers of Preschoolers (AAMCP), General Functioning subscale of the Family Assessment Device (GF-FAD), Parenting Stress Index Short Form (PSI-SF), and Quality of Life assessment scale for Caregivers of Asthmatic Children 24 (QOLCA-24).

RESULTS

A total of 45 participants were included in the analyses. The mean scores depicting asthma control were significantly improved postintervention (pre: 12.29 ± 2.65; post: 13.02 ± 2.01; t = -2.15, p = .037). Mean AAMCP scores postintervention (52.13 ± 6.25) were significantly greater than before (49.78 ± 7.20; t = -3.07; p = .004).

PRACTICE IMPLICATIONS

Adherence to asthma care and the recognition of asthma symptoms improved following the use of a web-based diary, making it a potential cost-effective intervention for asthma patients and their families.

Using the transtheoretical model's stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting

BACKGROUND

Qatar is currently experiencing a worrying increase in the prevalence of diabetes mellitus (DM). One of the most common reasons for uncontrolled DM is non-adherence to medications. The socio-behavioral intervention has proven effective in some chronic illnesses.

OBJECTIVES

To assess the stages of change (SOC) and medication adherence scores of type 2 diabetes mellitus (T2DM) patients visiting primary healthcare institutions in Qatar, and to evaluate the cause and effect relationship between SOC and adherence to antidiabetic medications.

METHODS

The 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence, and a 2-item SOC questionnaire was utilized to classify the SOC. The analysis to determine if the SOC could predict medication adherence while controlling for demographic characteristics, total number of prescribed medications and disease duration was done using hierarchical multiple regression.

RESULTS

The final analysis included 387 patients. In relation to medication adherence, majority of the patients were in the maintenance stage (76.7%), followed by the preparation stage (14.7%), the action stage (3.9%), the contemplation stage (3.4%) and the precontemplation stage (1.3%). Most of the patients were in high adherence towards antidiabetic medications (50.3%) followed by low level (26.4%) and medium level (23.3%). SOC was significant and positively predicted medication adherence, which accounted for around 58 to 60% (p < 0.001) while controlling for covariates.

CONCLUSIONS

SOC was significant and positively predicted medication adherence. The study recommends that the SOC questionnaire could potentially be used to identify patients at risk for low adherence.

Adherence to Treatment and Factors Affecting Adherence of Epileptic Patients at Yirgalem General Hospital, Southern Ethiopia: A Prospective Cross-Sectional Study

BACKGROUND

Non adherence of epileptic patients to antiepileptic medication often leads to an increased risk of seizures and worsening of disease, death and increased health care costs.

OBJECTIVE

to assess adherence to treatment and factors affecting adherence of epileptic patients at Yirgalem General Hospital, Southern Ethiopia.

METHODS AND MATERIALS

We conducted a cross-sectional study on epileptic patients from February 9 to 22, 2015. Data were collected from patients ≥18 years old. Adherence was measured using the eight-item Morisky's medication adherence scale. All consecutive patients coming to epilepsy clinic during the study period were interviewed until the calculated sample size (210) was obtained. We collected patient demographics, perception about epilepsy and adherence to medication(s). We used chi-square tests and a binary logistic regression model for statistical analysis. Statistical significance was considered at P<0.05.

RESULTS

out of a total of 210 participants, 194 were willing to participate and were studied. Of the 194 participants, 109 (56.2%) were males. The mean age of the participants was 33.62±11.44 years; range 18 to 66 years. The majority, 123(63.41%), of the participants were taking two antiepileptic medications. Sixty two (32%) of the participants were adherent to their treatment. The most common reported reasons for non-adherence were forgetfulness 49(75.4%) and run out of pills 7(10.8%). Factors that affect medication adherence are epilepsy treatment for <1 year (P = 0.011), epilepsy treatment for 1-3 years (P = 0.002), epilepsy treatment for 3-5 years (P = 0.007), being married (P = 0.006), grade 9-12 education (P = 0.028), college or university education (P = 0.002) and absence of co-morbidity (P = 0.008).

CONCLUSIONS

The rate of adherence observed in this study was low. The most common reason for non- adherence was forgetfulness. Therefore, the hospital should devise strategies to improve adherence of epileptic patients at the hospital.

Assessing barriers to a rational chemoprevention trial design in young patients with familial adenomatous polyposis

Familial adenomatous polyposis coli (FAP) is an autosomal dominant condition caused by a germline mutation in the adenomatous polyposis coli gene. Colonic adenomas form and almost all patients will develop colorectal cancer if they are not managed at an early stage. The safest preventive strategy is surgical resection of the colon, most commonly performed in late teenage years. There is a paucity of trials investigating the use of primary chemoprevention to delay polyp formation in paediatric FAP. There are extensive preclinical and early clinical data demonstrating that curcumin may be a safe and effective chemotherapeutic agent in reducing the polyp burden in this disease. We ultimately proposed to design and conduct a clinical study to assess whether curcumin treatment delays the need for surgery and/or prevents cancer in young patients with FAP. Research into clinical trial protocols has demonstrated that assessing patients' perceptions at the initial stage leads to better outcomes. We therefore conducted a questionnaire study of patients and parents of children affected by FAP to gain information to aid the protocol design. Results demonstrated that there are some FAP patients for whom this study is relevant and desirable. Those with a personal history of curcumin use reported that it was well tolerated. However, the response rate was poor (25%), indicating that there are potential difficulties ensuring adequate recruitment to the proposed trial. This report draws on lessons learnt from prior trials and the findings from the questionnaire to outline the challenges faced in designing such a study.

Factors associated with medication adherence in school-aged children with asthma

Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood.

Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted.

101 children (mean (range) age 8.9 (6–15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17–48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (−3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02).

In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations.

Girls, children of Asian ethnicity, small household size and younger diagnosis age have better adherence to asthmahttp://ow.ly/Z1y6Q

Adolescents' inhaled corticosteroid adherence: the importance of treatment perceptions and medication knowledge

BACKGROUND

Studies measuring inhaled corticosteroid (ICS) adherence frequently report adherence rates below 50%. Although asthma is common in adolescents, few studies have explored determinants of ICS adherence in adolescents. The objective of this study was to examine adherence and related factors in adolescent ICS users.

METHODS

Adolescent ICS users, aged 12-18 years, were randomly recruited from a sample of 94 community pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research to complete an online questionnaire. The survey contained questions on asthma control, self-reported adherence, medication beliefs and medication knowledge. Data were collected between April and August 2013.

RESULTS

Complete questionnaire data were received from 182 adolescents of which 40% reported to be adherent. Approximately 40% of the participants perceived strong needs, whilst only 10% was highly concerned about adverse effects regarding their ICS use. Good adherence was significantly associated with asthma control (OR: 2.1, 95% CI: 1.1-4.1). Necessity beliefs and sufficient medication knowledge were associated with better adherence (p < 0.05).

CONCLUSION

Our results suggest that by improving knowledge about asthma treatments and stimulating positive perceptions towards medicines, especially regarding the necessity of medication use, better adherence rates might be achieved.

Mobile phone-based asthma self-management aid for adolescents (mASMAA): a feasibility study

PURPOSE

Adolescents report high asthma-related morbidity that can be prevented by adequate self-management of the disease. Therefore, there is a need for a developmentally appropriate strategy to promote effective asthma self-management. Mobile phone-based technology is portable, commonly accessible, and well received by adolescents. The purpose of this study was to develop and evaluate the feasibility and acceptability of a comprehensive mobile phone-based asthma self-management aid for adolescents (mASMAA) that was designed to facilitate symptom monitoring, treatment adherence, and adolescent-parent partnership. The system used state-of-the-art natural language-understanding technology that allowed teens to use unconstrained English in their texts, and to self-initiate interactions with the system.

MATERIALS AND METHODS

mASMAA was developed based on an existing natural dialogue system that supports broad coverage of everyday natural conversation in English. Fifteen adolescent-parent dyads participated in a 2-week trial that involved adolescents' daily scheduled and unscheduled interactions with mASMAA and parents responding to daily reports on adolescents' asthma condition automatically generated by mASMAA. Subsequently, four focus groups were conducted to systematically obtain user feedback on the system. Frequency data on the daily usage of mASMAA over the 2-week period were tabulated, and content analysis was conducted for focus group interview data.

RESULTS

Response rates for daily text messages were 81%-97% in adolescents. The average number of self-initiated messages to mASMAA was 19 per adolescent. Symptoms were the most common topic of teen-initiated messages. Participants concurred that use of mASMAA improved awareness of symptoms and triggers, promoted treatment adherence and sense of control, and facilitated adolescent-parent partnerships.

CONCLUSION

This study demonstrates the utility and user acceptability of mASMAA as a potential asthma self-management tool in a selective group of adolescents. Further research is needed to replicate the findings in a large group of adolescents from sociodemographically diverse backgrounds to validate the findings.

Using Orem's self-care model for asthmatic adolescents

PURPOSE

The aim of the study was to determine the effect of Orem's self-care model on the self-care of adolescents with asthma.

DESIGN AND METHODS

In this experimental design, adolescents with asthma (N = 80) received home visits and individualized care based on theory-guided nursing diagnoses. Patients in the experimental group were visited in their homes eight times, and those in the control group were visited two times.

RESULTS

The five self-care skills of medicine usage, peak expiratory flow meter usage, applying an asthma action plan, keeping a daily follow-up schedule, and protecting against triggering factors differed significantly between the first and last visits in the experimental group, whereas the self-care skills of adolescents in the control group did not change.

PRACTICE IMPLICATIONS

Applying Orem's self-care model increased the self-care skills of adolescents with asthma.

A literature review to investigate the link between psychosocial characteristics and treatment adherence in cancer patients

Adherence to medication has been recognized as a key issue in health outcomes and efforts to improve patients' adherence are being made by the pharmaceutical industry, experts, and government bodies alike. This paper presents a review of these issues according to previous descriptive findings. Relevant studies written in English, published in 1976 or later, were identified through Medline, Embase and PsycInfo databases and reviewed. Review articles and clinical trials were excluded; all observational studies and surveys were considered. Articles were reviewed for any discussion of patients' characteristics and psychosocial characteristics affecting adherence to cancer treatment. The search strategy included a combination of key words adherence and cancer in titles. The major findings are summarized and presented under two main headings: i) patients' characteristics; and ii) psychosocial characteristics. In general, factors associated with increased likelihood of adherence to cancer treatment included younger age, higher education, higher income and Caucasian ethnicity. With regards to the psychosocial factors, lower levels of depression and anxiety, optimism as well as social support seemed to have a positive effect on treatment adherence. Studies of patterns of care in cancer treatment can help identify challenges in health care provided to particular subgroups of cancer patients and can aid researchers in designing studies that account for such factors in clinical and outcomes' research.

Impact of online support for youth with asthma and allergies: pilot study

Youth with asthma and allergies often feel isolated and different from their peers. The objective of this study was to test the impact of online social support for these youth. Three months of support was provided using weekly synchronous chat sessions. Online sessions were facilitated by trained peer mentors (older youth with asthma and/or allergies) and health professionals. Youth could also e-mail one another between chat sessions and post messages on an electronic community bulletin board. Twenty-eight adolescents across Canada participated. Social isolation and loneliness were significantly reduced. Youth reported gaining confidence and a sense of normality.

Factors affecting therapeutic compliance: A review from the patient's perspective

Objective

To explore and evaluate the most common factors causing therapeutic non-compliance.

Methods

A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance.

Results

A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory.

Conclusion

There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.

Genetic biomarkers of health-related quality of life in pediatric asthma

OBJECTIVES

To determine the relationship between single nucleotide polymorphisms in candidate genes associated with multiple asthma phenotypes and health-related quality of life (HRQOL).

STUDY DESIGN

A cross-sectional study was conducted at a pediatric hospital in 275 school-aged children diagnosed with asthma and their caregivers. Genomic DNA was obtained from children, and caregivers completed a measure of their child's HRQOL. Analysis of variance was used to investigate the association between single nucleotide polymorphisms and HRQOL.

RESULTS

Children homozygous for the major variant at IL-4RA rs 1805010 had significantly better HRQOL than their counterparts. Significant associations with pulmonary function were not observed.

CONCLUSIONS

Genes associated with asthma phenotype can be associated with HRQOL at least partly independent of pulmonary function.

The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma

OBJECTIVE

to develop and assess the feasibility of a motivational interviewing (MI) based asthma self-management program for inner-city, African-American, adolescents with asthma.

METHODS

37 African-American adolescents (age 10-15 years) recently seen in an inner-city emergency department for asthma and prescribed an asthma controller medication participated in the newly developed program consisting of 5 home visits. Adolescents and their caregivers completed phone-based surveys before and after the intervention.

RESULTS

95% of the adolescents completed all 5 sessions; 89% of caregivers and 76% of adolescents believed other families would benefit from the intervention. Caregivers were more likely to report 100% adherence post-intervention compared to pre-intervention and reported a trend for adolescents taking greater responsibility for their asthma. There were no pre-post-differences in adolescent-reported medication adherence, but adolescents did reported increased motivation and readiness to adhere to treatment. Caregivers and adolescents each reported statistically significant increases in their asthma quality of life.

CONCLUSIONS

the findings from this pilot study suggest that MI is a feasible and promising approach for increasing medication adherence among inner-city adolescents with asthma and is worthy of further evaluation in a randomized trial.

PRACTICE IMPLICATIONS

incorporating MI into disease management programs may enhance their effectiveness.

Health Professionals’ Preparation for Supporting Children and Parents Affected by Asthma and Allergies

Although social support originates from sources both informal (eg, family, peers) and formal (eg, health professionals), most reported research focuses on informal support providers. The perspectives and learning needs of health professionals as potential support providers for children and families affected by asthma and allergies form a gap in the reported research. The objective of this study was to assess health professionals’ learning needs and preferences pertinent to the support and education of children with asthma and allergies. A 26-item online survey and qualitative interviews (n, 10) elicited information from health professionals about the perceived support and educational needs of children with asthma and allergies, experience and challenges working with children, health professionals’ educational needs regarding support of children, and continuing education needs and barriers. Health professionals believed that children needed professional education, support, and strategies to reduce the effects of asthma and allergies on their lifestyle. Time (66.0%) and cost (80.9%) were significant barriers to non-Web-based education, but only 14.6% rated time and cost a barrier to Web-based education. Family or work commitments were slightly greater obstacles for non-Web-based education (63.8%) than for Web-based education (51.2%). Although these health professionals were interested in learning from and connecting with their peers, promoting peer support for children with asthma and allergies received a lower rating on their list of educational needs. This needs assessment study confirms that health professionals have limited time, funds, and options for asthma- and allergy-related professional development activities. It validates the need and value of Web-based education with access to an instructor, experts, and group discussions, and it supports the inclusion of asthma-specific information and practical skills for teaching children and for addressing challenges when teaching. Exposure to and understanding of the value of incorporating peer support and social support into existing health programs may be limited.

Family support and asthma outcomes in adolescents: barriers to adherence as a mediator

PURPOSE

Asthma morbidity in children is associated with family psychosocial functioning. Although the family plays a pivotal role in maintaining optimal asthma care, the mechanism of how family support influences asthma outcomes is not well understood. The purpose of this study was to examine the role of barriers to adherence in mediating the effect of family support on asthma outcomes in adolescents.

METHODS

The sample included 126 adolescents with asthma aged 13-20 years, living in the Northeast United States. The sample consisted of 49% Whites and 51% minorities, including primarily Blacks (38%) followed by Hispanic (11%). Adolescents provided self-reported data. Structural equation modeling was performed to examine the direct and indirect relationships between family support and asthma outcomes.

RESULTS

Family support was positively associated with asthma control and quality of life. These significant associations were mediated by barriers to adherence. Particularly, family support was found to reduce barriers concerning adolescents' negative attitudes toward medication and healthcare providers, which in turn improved asthma control and quality of life symptoms, emotional functioning, and activity domains. Adolescents' cognitive difficulty also tended to mediate the relationship between family support and emotional functioning.

CONCLUSION

This study highlights the beneficial effects of family support in improving asthma outcomes in adolescents. Family support exerts the positive effect by ameliorating barriers to treatment adherence in adolescents, particularly the barriers associated with negative attitudes and cognitive challenges. The findings underscore the importance of incorporating family assessment and intervention in caring for adolescents with asthma.

Management of multiple sclerosis in adolescents - current treatment options and related adherence issues

Multiple sclerosis (MS) is a progressive inflammatory demyelinating disorder of the central nervous system that is increasingly recognized in children and adolescents. This realization comes with additional concerns about existing therapeutic options and the impact of the disease on health-related outcomes of adolescents with MS. This five-part review provides an update on management strategies relevant to the pediatric MS population. The first section gives an overview on the epidemiology and natural history of early onset MS. The second section outlines currently available MS treatments, including medications during acute relapses and long-term immunomodulatory therapies. The third section highlights adherence issues pertaining to MS, including the challenges uniquely faced by adolescents. The fourth section provides a summary of research into quality of life and psychosocial consequences of pediatric onset MS. Attention is drawn to the grief experience of affected adolescents and the importance of peer relationships. Finally, the family resilience framework is presented as a conceptual model to facilitate optimal adaptation of adolescents with MS. Healthcare professionals can promote resilience and treatment adherence by ensuring that these individuals and their families are sufficiently informed about available MS treatments, providing instrumental support for managing potential medication side effects, and addressing age-appropriate developmental needs.

Adolescents and asthma: why bother with our meds?

BACKGROUND

Adherence to inhaled steroid regimens for asthma is poor in adults and children. Although it is assumed that nonadherence contributes to morbidity in older adolescents, investigation is limited.

OBJECTIVE

We sought to describe adherence to preventive asthma medications and explore relevant beliefs and attitudes in older urban adolescents, including their ideas for improving adherence.

METHODS

Quantitative and qualitative methods were used to collect data from a convenience sample of adolescents with asthma previously prescribed fluticasone/salmeterol (F/S). Two semistructured face-to-face interviews were conducted 1 month apart and analyzed for themes. F/S use was electronically monitored between visits and calculated as the number of actuations divided by the number of inhalations prescribed.

RESULTS

Forty participants, (15-18 years of age, 19 female subjects, 30 black/African American subjects, 11 Medicaid-insured subjects, and 24 previously hospitalized for asthma) with a median FEV1 of 98% of predicted value (range, 67% to 127%) had median adherence of 43% (range, 4% to 89%). Adherence was not associated with FEV1 or emergency department visits. Themes emerged from interviews as follows. Teens (1) take F/S inconsistently; (2) believe F/S is "supposed to help me breathe"; (3) dislike its taste; (4) are "too busy" and "forget"; and (5) recommend "reminder" solutions to poor adherence. Twenty percent believed that taking F/S was unnecessary, and another 18% expressed ambivalence about its benefits.

CONCLUSION

Adherence was poor. Examining and acknowledging health beliefs of older teens in the context of their complicated lives might facilitate discussions about self-management.

Quality of life in Jordanian children with asthma

The purpose of this study was to describe how Jordanian children with asthma experience their quality of life (QoL). Two hundred children with asthma (34% girls and 66% boys) participated in the study. The Paediatric Asthma Quality of Life Questionnaire was used to measure how children with asthma disease impaired their daily life during the previous week on three domains: 'activity limitations', 'symptoms' and 'emotional function'. The main finding of this study was that children with asthma scored their QoL towards the negative end of the scale, but they scored more limitations in the domain of activities than in emotions and symptoms. Children reported that the most restricted activity was their ability to run. Younger children, being a girl and living in the rural areas, were associated with lower QoL. The children in the present study might not comply with their health regimen, and this might gave a darker view of the daily life of children with asthma. Further studies of Jordanian children and their QoL were suggested to identify and support the factors which influence QoL of children with asthma and other chronic diseases in Jordan.

'What colour is my cancer?' The experience of teenagers and young adults who are shown their cancer samples through a microscope

One of the well-known needs of teenagers and young adults with cancer (TYAs) is their quest for knowledge about their illness and its treatment. As well as this they desire to be treated as partners and as an integral part of the team who care for them. This small exploratory study aims to address these issues in the development of a unique project where the young people were given unprecedented access to their own cancer samples and to the professional experts who analyse those samples. This small cohort of 31 TYAs, aged 13-24 years, were invited to look at their samples under a microscope and discuss it with the experts; of these 4 declined. A number of questionnaires, containing both open and closed questions, were given before, immediately post and one month after the viewing session. The results were analysed using SPSS13 and content analysis. The study was able to establish that viewing cancer samples had no measurable effect on the TYAs gaining of new knowledge, sense of control or choices that they made. However, it did show how the young people felt in light of actually 'seeing' their own cancer, and how this seemed to improve the overall perception of their disease. This is a new body of knowledge that requires further, more detailed, rigorous work.

Perceived adherence to prescribed treatment in juvenile idiopathic arthritis over a one-year period

OBJECTIVE

To document perceived adherence to treatment (taking medications and performing exercises) in patients with juvenile idiopathic arthritis (JIA) over a 1-year period and to identify related factors.

METHODS

We surveyed parents of patients with JIA at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Parents were asked to respond to a series of questionnaires every 3 months over a 12-month period. Perceived adherence was evaluated on a 100-mm visual analog scale (VAS) in the Parent Adherence Report Questionnaire (PARQ). Parental coping, distress, child function, disease severity and duration, perceived helpfulness of treatment, problems encountered, and sociodemographic data were also assessed.

RESULTS

The mean age of our sample of 175 children was 10.2 years; mean age at diagnosis was 6.1 years and mean disease duration was 4.1 years. Perceived adherence to medications was consistently high, with average adherence at baseline, 3, 6, 9, and 12 months being 86.1, 91.7, 90.4, 92.0, and 88.8, respectively, on the PARQ VAS. Perceived adherence to exercise was lower but remained steady, with corresponding means of 54.5, 64.1, 61.2, 63.0, and 54.3, respectively. Using generalized estimating equation analysis, factors associated with higher perceived adherence to medications included perceived helpfulness of medications and lower disease severity; those associated with higher perceived adherence to exercise were younger age of the child, child involvement in responsibility for treatment, and higher perceived helpfulness of the treatment.

CONCLUSION

Belief in helpfulness of treatment is associated with higher parental perceived adherence to treatment.

Not letting the disease get the upper hand over life: strategies of teens with asthma

Adolescence is a period when teens normally revolt against being dependent. For teens with asthma this period may be even more difficult to deal with, as they also have to deal with their illness. Since few studies describe this phenomenon, the aim of this study was to provide a theoretical understanding of how teens with asthma manage their everyday life in relation to their disease. A grounded theory research design, according to Glaser, was used to uncover the phenomenon. The study was undertaken at a camp for teenagers with asthma during the summer of 2003. Twelve girls and 11 boys with moderate to severe asthma participated in the study. Participant observations and interviews were used, and the first author collected the data and participated in the activities. The findings reveal a theoretical model which shows that teens' core concern is not to let the disease get the upper hand over life. To manage this core concern the teens were found to use three strategies: keeping a distance to the disease, challenging the disease and taking the disease into consideration. Boys mainly kept a distance to the disease while girls mainly kept the disease into consideration. Challenging the disease seemed to be a strategy used by both girls and boys. The teens' strategies were not studied close to their everyday life, but a conclusion drawn from our study was that the provisional theory in many respects can be transferred to their everyday life, even though further research is needed to develop this provisional theory in other settings.

Medication adherence among adolescents in a school-based health center

School-based health centers are an integral part of the health care delivery system for low-income children. Medication adherence for these patients may be challenging because the student is often responsible for bringing home the prescription and receiving the instructions. This study assesses medication fill, initiation, and adherence rates among adolescents in a school-based health center to identify major barriers to medication compliance. Students enrolled in a school-based health center, >or=10 years old, able to read and write English, and whose parent had provided consent for participation, were eligible for the study. Eligible students who received a prescription from the health center were invited to return to the clinic a week later to complete a questionnaire (with verbal assent). Primary outcome measures included medication fill rates, medication initiation rates, medication adherence rates, and reasons for nonadherence. Eighty-one students completed the questionnaire: 45 students (55.6%) filled their prescription. Of the students who filled their prescriptions, 75.6% reported always taking their medication at the appropriate time, 22.2% reported sometimes forgetting to take their medication, and 2.2% reported never taking the medication. However, many discrepancies were found between reported medication-taking behavior and the instructions provided to the student. Medication fill, initiation, and adherence rates among students receiving prescriptions for medications in school-based health centers are suboptimal. Interventions that address key identified barriers need to be developed and evaluated in order to achieve optimal fill and adherence rates.

Comparison between children with juvenile idiopathic arthritis and their parents concerning perceived treatment adherence

OBJECTIVE

Adherence to treatment in juvenile idiopathic arthritis (JIA) may be associated with better outcomes. Clinicians must be aware of possible divergence between parents and children regarding adherence, in order to gain a better understanding of adherence and factors associated with it. The objective was to determine the level of agreement between children with JIA and their parents concerning perception of the child's adherence to the treatment regimen (for both medications and exercises).

METHODS

Fifty patients and their parents, who attended the JIA clinic at the Montreal Children's Hospital, completed the Child Adherence Report Questionnaire and the Parent Adherence Report Questionnaire. Paired t-tests were used to compare parents' and children's scores for adherence questions and agreements were analyzed by intraclass correlation coefficients (ICCs).

RESULTS

Parents reported that their children showed more negative reactions to taking medication and doing exercises, more helpfulness from the medication, and more difficulty to carry out the exercise program than their children reported. ICCs (95% confidence interval) for medications and exercises were, respectively, 0.32 (0.04, 0.56) and 0.77 (0.61, 0.87) for overall adherence, 0.33 (0.05, 0.57) and 0.39 (0.09, 0.62) for perceived difficulty to following treatment, and 0.37 (0.09, 0.60) and 0.45 (0.17, 0.67) for how often children had negative reactions following treatment. Levels of agreement for perceived helpfulness of treatments were quite low.

CONCLUSION

Agreement between parents and children concerning adherence was at best moderate, and generally better for the exercise program than for prescribed medications.

Asthma--quality of life for Swedish children

AIMS AND OBJECTIVES

The purpose of this study was to describe how Swedish children with asthma experience their QoL and to search for possible associations between their experience of QoL and some determinants.

BACKGROUND

Asthma is a chronic disorder that can restrict a child's life, physically, emotionally, socially and spiritually, and this has an impact on a child's quality of life (QoL).

METHODS

Two hundred and twenty-six children with asthma (37% girls and 63% boys) and 371 parents of these children participated in the study. The Paediatric Asthma Quality Of Life Questionnaire (PAQLQ) was used to measure the children's QoL. This questionnaire reveals how the children's asthma interferes with their normal activities, their symptoms and how this interference has made them feel.

RESULTS

The findings show that most children with asthma estimated their QoL towards the positive end of the scale. The children reported more impairment in the domain of activities than in emotions and symptoms. The most commonly restricted activity was the children's ability to run. Significant associations were found between a higher QoL outcome and being a boy, as well as living in the south of Sweden. A higher QoL was also found in children with mothers older than 40 years of age and in children with cohabiting parents. It was also associated with their fathers' QoL in a positive direction.

CONCLUSIONS

It is important that children with asthma will maintain a high QoL. In this study the children were being treated with asthma medication when they evaluated their QoL. Perhaps this fact might have influenced the results in a positive direction.

RELEVANCE TO CLINICAL PRACTICE

The findings of our study underline the importance of accurate nursing assessment including background variables of the children. Nurses also have to be aware that some of the children in the study have a low QoL and these children must not be forgotten. In addition, as caring tends to focus on the patients' limitations, another important issue for nurses is to try to discover those aspects in a child's daily life that contribute to a high QoL in order to improve and maintain the child's wellbeing.

Psychological characteristics of adolescents with good or poor asthma control

The main purpose of this study was to investigate what are the psychological differences between adolescents with poor or good asthma control. One hundred and twenty one adolescents participated in the study, aged 12 to 16. Participants were assigned to one of three groups - one being a control group, with adolescents that had no medical illness, and two experimental, with adolescents either having poor or good control of their asthma. The assessment of asthma control was based on several criteria groups. It has been found that adolescents differ among each other across majority of variables - coping strategies, presence of depressive characteristics, anxiety, locus of control, as well as their perception of social support.

Implementing asthma education programmes in paediatric respiratory care: settings, timing, people and evaluation

Randomised controlled trials have shown that asthma education programmes in paediatric care can improve the ability of children and their parents to control their asthma. This paper discusses the implementation of asthma education within pragmatic care. Key times for implementation are suggested: at the initial diagnosis, after acute asthma events such as hospitalisation, at the time of medication change and at regular review. Special issues, such as implementing programmes for teenagers, are discussed. Evaluation is recommended for processes (does the practice have an agreed protocol for education, does it have a key person with responsibility for co-ordinating education within the clinic or practice, does it have agreed outcomes for audit of education?). Evaluation is also recommended for individual outcomes (clinical improvement and increase in perceived asthma control and confidence in management).

Managing asthma in the real world

Asthma treatment is suboptimal in many patients, with impacts on morbidity and mortality, healthcare resource utilisation and patients' quality of life. The reasons for this include the inherent variability of asthma and the unpredictability of exacerbations, which can range from mild to fatal. In addition, asthma can be difficult to diagnose, particularly in the very young and old. Although treatment guidelines are widely available and well publicised, surveys have identified a significant gap between treatment aims and current levels of asthma control. Patient adherence to inhaled corticosteroids is poor, and many patients rely on short-acting beta2-agonists. The reasons for this are complex but are believed to include poor perception by patients of their asthma severity, concerns about the safety and efficacy of medication and low treatment expectations. Patients appear to be unaware of the extent to which airway inflammation can be controlled and are therefore satisfied with poor asthma control, accepting a high level of symptoms. Increasing patient understanding of asthma and its treatment, allowing patients greater involvement in treatment decisions, increasing the role of asthma nurses and improved communication between physicians and patients may improve outcomes in patients with asthma.

Patient education: perspective of adolescents with a chronic disease

The purpose of this study was to describe patient education from the perspective of adolescents. Data were collected by interviewing adolescents who had asthma, epilepsy, juvenile rheumatoid arthritis, and insulin-dependent diabetes mellitus. The sample consisted of 40 Finnish adolescents aged between 13 and 17 years. The interview data were analysed with methods of content analysis. From the perspective of adolescents with a chronic disease, patient education can be divided into the following categories: routine programmes, problematic planning issues, atmosphere of patient education session and written patient education material. Some features of ideal patient education also emerged. In a routine programme, patient education was based on the professional knowledge of the physicians and nurses rather than the needs of the adolescents. It was provided at a time that was good for the nurses or physicians. The level of education was not compatible with each developmental level of the adolescent. Problematic planning issues included a poorly outlined plan of education and a lack of systematic and continuous education. Educational communication consisted of dialogue between the adolescent and the educator. An encouraging atmosphere developed when the educators motivated the adolescents, respected them and their opinions and encouraged them to express their feelings, to ask questions and to relate experiences. Also, it was important that the adolescents' opinions were respected. In ideal patient education, the sessions had been planned well beforehand based on the adolescents' needs and written patient education material. Ideal patient education helped adolescents to acquire skills to take care of themselves and provided information on how to adjust to different situations and problems. The results provided useful insight into patient education and served to raise awareness of the problems and difficulties experienced by adolescents with a chronic disease.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.