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Rhee H, Batek L, Rew L, Tumiel-Berhalter L. Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1510. [PMID: 37761471 PMCID: PMC10527731 DOI: 10.3390/children10091510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA;
| | - Lynn Rew
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA;
| | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA;
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Bach LM, Rubak S, Holm-Weber A, Prahl J, Hermansen M, Hansen KS, Chawes B. Risk Factors for Non-Adherence to Inhaled Corticosteroids in Preschool Children with Asthma. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010043. [PMID: 36670594 PMCID: PMC9856475 DOI: 10.3390/children10010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Non-adherence to asthma controllers increases morbidity among school-aged children. This study aimed to determine non-adherence risk factors in preschool children with asthma. We investigated 172 children <6 years diagnosed with asthma in 2018 and analyzed baseline characteristics and loss of control events extracted from the medical records for four years following diagnosis. At end of follow-up, 79 children had a prescription of inhaled corticosteroids (ICS) and were included in the analyses. Adherence was assessed in a two-year period through pharmacy claims using percentage of days covered (PDC) analyzed dichotomously with non-adherence defined as PDC < 80% and using adherence ratio (AR) defined as days with medical supply divided by days without. Of the 79 children, 59 (74.7%) were classified as non-adherent. In analyses adjusted for sex, age and exacerbations prior to inclusion, adherence was positively associated with having had a loss of control event requiring a step-up in asthma controller (aAR:2.34 [1.10;4.98], p = 0.03), oral corticosteroids (aAR:2.45 [1.13;5.34], p = 0.026) or redeeming a short-acting b2-agonist prescription (aAR:2.91 [1.26;6.74], p = 0.015). Further, atopic comorbidity was associated with increased adherence (aAR:1.18 [1.01;1.37], p = 0.039), whereas having a first degree relative with asthma was associated with worse adherence (aAR:0.44 [0.23;0.84], p = 0.015). This study found poor adherence to ICS among three quarters of preschool children with asthma. Increasing adherence was associated with atopic comorbidity and loss of control events, whereas lower adherence was associated with atopic predisposition. These findings should be considered to improve adherence in preschool children with asthma.
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Affiliation(s)
- Louise Mandrup Bach
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Danish Center of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescents Medicine, Institute of Clinical Medicine, University Hospital of Aarhus, University of Aarhus, 8000 Aarhus, Denmark
| | - Sune Rubak
- Danish Center of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescents Medicine, Institute of Clinical Medicine, University Hospital of Aarhus, University of Aarhus, 8000 Aarhus, Denmark
| | - Adam Holm-Weber
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Julie Prahl
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Mette Hermansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Allergy Clinic, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark
| | - Bo Chawes
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Correspondence: ; Tel.: +45-3868-1152
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Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1573. [PMID: 36291509 PMCID: PMC9600616 DOI: 10.3390/children9101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | | | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 77 Goodell St., Buffalo, NY 14203, USA
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Azzi E, Kritikos V, Peters M, Price D, Cvetkovski B, Alphonse PS, Bosnic-Anticevich S. Perceptions, attitudes, and behaviors of short-acting beta 2 agonist users: an Australian cross-sectional community pharmacy-based study. J Asthma 2020; 59:178-188. [PMID: 33086885 DOI: 10.1080/02770903.2020.1841223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High use of short-acting beta-2-agonist (SABA) medication is a significant problem. Attitudes and perceptions toward asthma of over-the-counter (OTC) reliever users are unknown. The study aimed to describe the asthma attitudes, perceptions, medication knowledge and information gathering behavior of people with asthma with recent high SABA use (i.e. SABA use > twice a week in the last 4 weeks) and compare them to people with asthma with no recent high SABA use. METHOD A real-world cross-sectional observational study in Australian community pharmacies was conducted; surveying patients ages ≥ 16 years requesting SABA medication OTC. Data collected included; demographics, medication usage, asthma control, asthma-related perceptions and behaviors. Data were summarized by using descriptive analyses. RESULTS 375 participants completed the survey, 73.9% were high SABA users. Of the 375, 90.4% reported that their asthma symptoms were controlled or somewhat controlled and 56.0% felt that their asthma was not serious. However, only 17.6%, had controlled asthma according to GINA-defined criteria. High SABA users tended to be more anxious about their asthma and worried about its impact in the future (50.5% vs. 28.6%, p < 0.001). High SABA users were more likely to agree with the statements suggesting that asthma impacted on activities of daily living (46.6% vs. 16.3%, p < 0.001); were socially conscious about their asthma and more likely to feel embarrassed carrying (21.3% vs 9.2%, p = 0.007) and using (29.2% vs 18.4%, p = 0.036) their asthma inhaler. CONCLUSION This study revealed the extent of uncontrolled asthma and uncovered an anxious and socially conscious group of OTC SABA users. There is a need to better understand patient perceptions and their relationships to high-SABA use, to ensure targeted educational interventions are developed and implemented.
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Affiliation(s)
- Elizabeth Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia.,School of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Matthew Peters
- Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia.,Emphysema Centre, Woolcock Institute of Medical Research, Glebe, Australia
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Pamela Srour Alphonse
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
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Roberts G, Vazquez‐Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Garriga‐Baraut T, Gore C, Gowland MH, Hox V, Jensen B, Mortz CG, Pfaar O, Pite H, Santos AF, Sanchez‐Garcia S, Timmermans F. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020; 75:2734-2752. [PMID: 32558994 DOI: 10.1111/all.14459] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
Abstract
Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self-manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence-based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11-13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio-economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self-management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.
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Affiliation(s)
- Graham Roberts
- Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Marta Vazquez‐Ortiz
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | | | - Cherry Alviani
- Faculty of Medicine University of Southampton Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Isle of Wight UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology, Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine Section of Paediatrics University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Teresa Garriga‐Baraut
- Unitat d'Allergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d'Investigació “Creixement i Desenvolupament” Institut de Recerca de l'Hospital Universitari Vall d'Hebron (VHIR) Barcelona Spain
| | - Claudia Gore
- Section of Inflammation, Repair and Development National Heart and Lung Institute Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | | | - Valérie Hox
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital Odense C Denmark
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children's Health (Paediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King's College London London UK
- Children's Allergy Service Guy's and St Thomas' Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | | | - Frans Timmermans
- Nederlands Anafylaxis Netwerk—European Anaphylaxis Taskforce Dordrecht The Netherlands
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
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Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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Ludden T, Shade L, Welch M, Halladay J, Donahue KE, Coyne-Beasley T, Bray P, Tapp H. What types of dissemination of information occurred between researchers, providers and clinical staff while implementing an asthma shared decision-making intervention: a directed content analysis. BMJ Open 2020; 10:e030883. [PMID: 32152153 PMCID: PMC7064133 DOI: 10.1136/bmjopen-2019-030883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To qualitatively analyse different types of dissemination of information during monthly group calls between researchers, providers and clinical staff used to establish best practices for implementing an asthma shared decision-making (SDM) intervention. Evaluating dissemination of information can provide a better understanding of how best practices are shared, informing implementation approaches to improve the uptake of new evidence and overcome barriers. SETTING 10 primary care practices in North Carolina. PARTICIPANTS Providers and clinical staff participated in monthly group phone calls with researchers to share best practices during implementation of a SDM intervention for asthma patients. DESIGN The research team transcribed and coded statements using content analysis into three different knowledge types: Knowledge Position, Knowledge Form and Knowledge Object. Knowledge Objects were further classified using directed content analysis where the research team interpreted the content objects through a classification process of identifying themes or patterns to describe three different types of dissemination of information: (A) Confirmation of Existing Knowledge, (B) Generation of New Knowledge and (C) Spreading of New Knowledge. RESULTS Across the 8 transcripts, 4 Knowledge Positions, 7 Knowledge Forms and 18 types of Knowledge Objects were identified. From the Knowledge Objects, Confirmation of Existing Knowledge occurred during the training of participating practices. The review also identified Generation of New Knowledge by providers and clinical staff raised in these calls. This Generation of New Knowledge was later documented being used by other practices with the identification of Spreading of New Knowledge. CONCLUSION The research team described the types of dissemination of information that occurred between researchers, providers and clinical staff during implementation of an asthma SDM intervention. Both Confirmation of Existing Knowledge and Generation of New Knowledge in response to barriers occurred. These exploratory dissemination of information results provide additional mechanisms for evaluating implementation science. TRIAL REGISTRATION NUMBER NCT02047929; Post-results.
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Affiliation(s)
- Thomas Ludden
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Madelyn Welch
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jacqueline Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katrina E Donahue
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tamera Coyne-Beasley
- Department of Pediatrics and Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Bray
- Community Based Care, Vidant Medical Center, Greenville, North Carolina, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, USA
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Amin S, Soliman M, McIvor A, Cave A, Cabrera C. Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies. Patient Prefer Adherence 2020; 14:541-551. [PMID: 32210541 PMCID: PMC7071882 DOI: 10.2147/ppa.s234651] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/30/2020] [Indexed: 01/11/2023] Open
Abstract
Adherence to asthma medications is generally poor and undermines clinical outcomes. Poor adherence is characterized by underuse of inhaled corticosteroids (ICS), often accompanied by over-reliance on short-acting β2-agonists for symptom relief. To identify drivers of poor medication adherence, a targeted literature search was performed in MEDLINE and EMBASE for articles presenting qualitative data evaluating medication adherence in asthma patients (≥12 years old), published from January 1, 2012 to February 26, 2018. A thematic analysis of 21 relevant articles revealed several key themes driving poor medication adherence, including asthma-specific drivers and more general drivers common to chronic diseases. Due to the episodic nature of asthma, many patients felt that their daily life was not substantially impacted; consequently, many harbored doubts about the accuracy of their diagnosis or were in denial about the impact of the disease and, in turn, the need for long-term treatment. This was further compounded by poor patient-physician communication, which contributed to suboptimal knowledge about asthma medications, including lack of understanding of the distinction between maintenance and reliever inhalers, suboptimal inhaler technique, and concerns about ICS side effects. Other drivers of poor medication adherence included the high cost of asthma medication, general forgetfulness, and embarrassment over inhaler use in public. Overall, patients' perceived lack of need for asthma medications and medication concerns, in part due to suboptimal knowledge and poor patient-physician communication, emerged as key drivers of poor medication adherence. Optimal asthma care and management should therefore target these barriers through effective patient- and physician-centered strategies.
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Affiliation(s)
- Suvina Amin
- US Oncology Medical Affairs, AstraZeneca, Gaithersburg, MD, USA
- Correspondence: Suvina Amin AstraZeneca, One Medimmune Way, Gaithersburg, MD20878, USATel +1 800 565 5877 Email
| | - Mena Soliman
- BioPharmaceuticals Medical (Europe and Canada), AstraZeneca, Mississauga, ON, Canada
| | - Andrew McIvor
- Department of Medicine, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada
| | - Andrew Cave
- Department of Family Medicine, University of Alberta, Edmonton, AL, Canada
| | - Claudia Cabrera
- BioPharmaceuticals Medical (Evidence), AstraZeneca, Gothenburg, Sweden
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Almunef M, Mason J, Curtis C, Jalal Z. Young People and the Management of Chronic Illness by Primary Care Pharmacists: A Systematic Review. PHARMACY 2019; 7:E89. [PMID: 31373321 PMCID: PMC6789880 DOI: 10.3390/pharmacy7030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022] Open
Abstract
Recent evidence has shown that the incidence of long-term illnesses in young people aged 10-24 years is increasing. It is essential to highlight the importance of long-term health conditions in this age group and understand young people's health needs to be able to improve current support for young people. Pharmacists, as medicine experts, are in a unique position to promote young people's health. The role of primary care pharmacists in the management of chronic illnesses in young people has not been widely researched. The aim of this review was to explore the current role of primary care pharmacists in the management of chronic illnesses in young people aged 10-24 years. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using Medical Subject Headings (MeSH) and Embase subject headings (Emtree) terms, covering three main themes: Pharmacists, young people and chronic illnesses. Articles were critically appraised using Critical Appraisal Skills Programme (CASP) tools. Eight articles were included in this review. Seven articles included original research studies (one observational study, two surveys, two qualitative interview studies and two interventions). The remaining article was a literature review. All of the articles made reference to community pharmacists, while there was no information about GP pharmacists. Roles that community pharmacists identified as high-priority in their practice when dealing with young people included supporting young people to develop generic healthcare skills, counselling and building trusted relationships directly with young people, helping young people to find credible health information and the provision of specialist services. Community pharmacists feel that they have a role to play in supporting young people with chronic illness and have identified many areas where they can provide services and support.
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Affiliation(s)
- Mohammed Almunef
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Julie Mason
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Chris Curtis
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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11
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Lycett H, Wildman E, Raebel EM, Sherlock JP, Kenny T, Chan AHY. Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence. Respir Med 2018; 141:180-189. [PMID: 30053965 DOI: 10.1016/j.rmed.2018.06.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/25/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma. AIM The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data. METHODS Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence. RESULTS Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment - all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment - immediate and long-term side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma - 22% of studies reported that embarrassment contributed to poor adherence. CONCLUSIONS Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.
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Affiliation(s)
- Helen Lycett
- Spoonful of Sugar Ltd, UCL Business PLC, The Network Building, 97 Tottenham Court Road, London, W1T 4TP, UK
| | - Emilie Wildman
- Spoonful of Sugar Ltd, UCL Business PLC, The Network Building, 97 Tottenham Court Road, London, W1T 4TP, UK
| | - Eva M Raebel
- Spoonful of Sugar Ltd, UCL Business PLC, The Network Building, 97 Tottenham Court Road, London, W1T 4TP, UK.
| | - Jon-Paul Sherlock
- AstraZeneca, Macclesfield Campus, Charter Way, Macclesfield, SK10 2NA, UK
| | - Tom Kenny
- Spoonful of Sugar Ltd, UCL Business PLC, The Network Building, 97 Tottenham Court Road, London, W1T 4TP, UK
| | - Amy Hai Yan Chan
- Spoonful of Sugar Ltd, UCL Business PLC, The Network Building, 97 Tottenham Court Road, London, W1T 4TP, UK; Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, Tavistock House North, Tavistock Square, London, WC1H 9HR, UK
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12
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Welch M, Ludden T, Mottus K, Bray P, Hendrickson L, Rees J, Halladay J, Tapp H. Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices. J Asthma 2018; 56:562-572. [PMID: 29927661 DOI: 10.1080/02770903.2018.1471703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Poor outcomes and health disparities related to asthma result in part from difficulty disseminating new evidence such as shared decision making (SDM) into clinical practice. As part of a three-arm cluster randomized dissemination study, evaluation of the impact of different dissemination methods was studied. Here we evaluate themes from patient and provider focus groups to assess the impact of a facilitated, traditional dissemination approach, or no intervention, on patient and provider perspectives of asthma care. METHODS Using semi-structured questions, twenty-four pre- and post-intervention focus groups with patients and providers took place across primary care practices. Discussions were held in all three arms both before and after the time of intervention rollout. Audio recordings were transcribed and analyzed for themes. RESULTS Across all sites patients and providers discussed themes of communication, asthma self-management, barriers, education, and patient awareness. After the intervention, compared to traditional sites, facilitated practices were more likely to discuss themes related to SDM, such as patient-centered communication, patient-provider negotiation on treatment plan, planning, goal-setting, and solutions to barriers. CONCLUSIONS Emergent themes allowed for further understanding of how the SDM implementation was perceived at the patient and provider level. The facilitated implementation was associated with higher adoption of the SDM intervention. These themes and supporting quotes add to knowledge of best practices associated with implementing an evidence-based SDM intervention for asthma into primary care and will inform researchers, practices, and providers as they work to improve adoption of evidence-based interventions into practice.
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Affiliation(s)
- Madelyn Welch
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Thomas Ludden
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Kathleen Mottus
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Paul Bray
- c Vidant Medical Group , Greenville , NC , USA
| | | | - Jennifer Rees
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - Hazel Tapp
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
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13
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Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR. Medication adherence in pediatric asthma: A systematic review of the literature. Pediatr Pulmonol 2018; 53:668-684. [PMID: 29461017 DOI: 10.1002/ppul.23966] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains. METHODS Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality. RESULTS Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies. CONCLUSIONS All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University, Auburn University, AL
| | - Mallory Netz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Scott T Wagoner
- Department of Psychology, Auburn University, Auburn University, AL
| | - Megan R Schaefer
- Department of Psychology, Auburn University, Auburn University, AL
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14
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Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. PATIENT EDUCATION AND COUNSELING 2018; 101:687-695. [PMID: 29129307 PMCID: PMC5878979 DOI: 10.1016/j.pec.2017.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents. METHODS Fourty-two inner-city adolescents (ages 16-20) participated in a 12hour asthma self-management training program. Self-management knowledge, attitude toward asthma, and asthma-related self-efficacy were measured using short-answer tests before and after training. T-Tests were used to evaluate impact and effect sizes were calculated. RESULTS Mean pretest knowledge was 21.37/46 points; mean posttest was 36.33/46 points. Change from pre- to posttest was highly significant (t=10.34; p<0.0001), with a large effect size (d=1.68). Females improved more than males (18.66±8.58 vs. 12.29±8.13, p=0.039). Greatest effects were seen in awareness of long-term consequences of uncontrolled asthma (d=2.04), ability to recognize symptoms of life-threatening asthma (d=1.61), correctly monitor symptoms (d=1.49), and tell if asthma was uncontrolled (d=1.39). Asthma self-efficacy also improved significantly (p=0.017), particularly confidence in ability to correctly manage asthma, however improvements in attitude did not achieve statistical significance. CONCLUSION Developmentally appropriate training is effective in increasing critical self-management knowledge and self-efficacy in inner city adolescents, particularly females. PRACTICE IMPLICATIONS Providers should screen carefully for symptoms and educate using developmentally appropriate training materials on ways to correctly monitor and manage symptom.
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Affiliation(s)
- Jennifer R Mammen
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States.
| | - Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Shannska Atis
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Annette Grape
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
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15
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Rhee H, Wicks MN, Dolgoff JS, Love TM, Harrington D. Cognitive factors predict medication adherence and asthma control in urban adolescents with asthma. Patient Prefer Adherence 2018; 12:929-937. [PMID: 29872278 PMCID: PMC5973469 DOI: 10.2147/ppa.s162925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Adolescents with asthma often report poor medication adherence and asthma control. Cognitive factors embedded in the social cognitive theory including self-efficacy, outcome expectations, and barrier perceptions may explain poor asthma outcomes in this population. This study was performed to examine the extent to which these cognitive factors are intercorrelated and explain medication adherence and asthma control in urban adolescents. PATIENTS AND METHODS A total of 373 urban adolescents (12-20 years) with asthma completed questionnaires measuring asthma-related self-efficacy, outcome expectations, barrier perceptions, medication adherence, and asthma control. Multiple linear regression was conducted to examine the extent to which the three cognitive factors predicted medication adherence and asthma control after controlling for covariates including age, sex, household income, and age at diagnosis. RESULTS Participants' ages were on average 14.68 (±1.94) years; 50% were female, and most (78.6%) were African American. Higher self-efficacy associated with lower barrier perceptions and higher outcome expectations (r=0.50, p<0.001; r=-0.26, p<0.001, respectively). Self-efficacy predicted better asthma control (B=-0.098, p=0.004) and adherence (B=0.426, p=0.011), whereas barrier perceptions predicted poorer asthma control (B=0.13, p<0.001) and adherence (B=-0.568, p<0.001). Self-efficacy independently predicted fewer missed doses (B=-0.621, p=0.006), and barrier perception independently predicted asthma control (B=0.12, p<0.001) and adherence (B=-0.519, p<0.001). CONCLUSION Improving medication adherence and asthma control among adolescents may require a multifaceted approach. Interventions focused on increasing self-efficacy and addressing barriers, actual or potential, to medication adherence could ameliorate asthma disparities in urban adolescents.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester School of Nursing, Rochester, NY, USA
- Correspondence: Hyekyun Rhee, University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642, USA, Tel +1 585 276 3775, Fax +1 585 273 1270, Email
| | - Mona N Wicks
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer S Dolgoff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tanzy M Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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16
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Jonsson M, Schuster M, Protudjer JLP, Bergström A, Egmar AC, Kull I. Experiences of Daily Life Among Adolescents With Asthma - A Struggle With Ambivalence. J Pediatr Nurs 2017; 35:23-29. [PMID: 28728764 DOI: 10.1016/j.pedn.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/25/2017] [Accepted: 02/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE There is limited knowledge about how adolescents with asthma view their disease in daily life and how these views impact on management. The aim of this study was to describe experiences of daily life, with particular focus on thoughts, feelings and management of adolescents with asthma. METHODS In this qualitative study, data were obtained from 10 interviews with adolescents (aged 16-18 years) with asthma recruited from the Swedish population-based prospective birth cohort, BAMSE. Data were analysed through Systematic Text Condensation. RESULTS Experiences of daily life among adolescents with asthma were defined in four categories: Insight and understanding; Asthma not the focus of daily life; Being acknowledged and, Being affected by asthma symptoms. The adolescents had developed an insight into and understanding of their disease, but did not want asthma to be the focus of their daily lives. The adolescents wanted their asthma to be acknowledged, but not to the point that they were defined by their asthma. They reported having many asthma symptoms, especially during physical activity, but also described a desire to feel healthy, "normal" and like their peers. CONCLUSIONS Having asthma in adolescence involves several struggles with ambivalence between adapting socially, feeling healthy and managing one's asthma. IMPLICATIONS IN CLINICAL PRACTICE The provision of person-centred care may be one way to handle the ambivalence among adolescents with asthma and thereby help them to manage their asthma.
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Affiliation(s)
- Marina Jonsson
- Centre of Occupational and Environmental Medicine, Stockholm County Council, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Sweden.
| | - Marja Schuster
- The Swedish Red Cross University College, Department of Technology and Welfare, Sweden
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Allergy Research, Karolinska Institutet, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Allergy Research, Karolinska Institutet, Sweden
| | - Ann-Charlotte Egmar
- The Swedish Red Cross University College, Department of Public Health and Medicine, Sweden; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Sweden
| | - Inger Kull
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; Sachs' Children's Hospital, Södersjukhuset, Sweden; Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Sweden
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17
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Holley S, Morris R, Knibb R, Latter S, Liossi C, Mitchell F, Roberts G. Barriers and facilitators to asthma self-management in adolescents: A systematic review of qualitative and quantitative studies. Pediatr Pulmonol 2017; 52:430-442. [PMID: 27717193 DOI: 10.1002/ppul.23556] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many adolescents have poor asthma control and impaired quality of life despite the availability of modern pharmacotherapy. Research suggests that poor adherence to treatment and limited engagement in self-management could be contributing factors. OBJECTIVE To conduct a systematic review of the barriers and facilitators to self-management of asthma reported by adolescents using a narrative synthesis approach to integrate the findings. DESIGN MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for all types of study design. Full papers were retrieved for study abstracts that included data from participants aged 12-18 years referring to barriers or facilitators of asthma self-management behaviors. RESULTS Sixteen studies (5 quantitative and 11 qualitative) underwent data extraction, quality appraisal, and thematic analysis. Six key themes were generated that encompassed barriers and/or facilitators to self-management of asthma in adolescents: Knowledge, Lifestyle, Beliefs and Attitudes, Relationships, Intrapersonal Characteristics, and Communication. CONCLUSIONS There is a pressing need to prepare adolescents for self-management, using age-appropriate strategies that draw on the evidence we have synthesized. Current clinical practice should focus on ensuring adolescents have the correct knowledge, beliefs, and positive attitude to self-manage their illness. This needs to be delivered in a supportive environment that facilitates two-way communication, fosters adolescents' self-efficacy to manage their disease, and considers the wider social influences that impinge on self-management. Pediatr Pulmonol. 2017;52:430-442. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Simone Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Ruth Morris
- NIHR/Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- School of Psychology, University of Southampton, United Kingdom.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Frances Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, United Kingdom
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton Faculty of Medicine, Southampton, United Kingdom.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, United Kingdom.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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18
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Ahmad A, Sorensen K. Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review. J Asthma 2016; 53:862-78. [PMID: 27053332 DOI: 10.3109/02770903.2016.1155217] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this systematic literature review is to study the enabling and hindering factors influencing adherence to asthma treatment among adolescents. Furthermore, it explores the role of caregivers and the healthcare provider in terms of supporting adolescents to manage and live with asthma. DATA SOURCES The literature review was conducted using the MeSH terms asthma, adherence, health literacy, behavior, adolescents, tools, healthcare provider, caregiver, peer influence, self-management, quality of life, morbidity and mortality in PubMed, PsycInfo, MEDLINE and CINAHL. STUDY SELECTION The literature search resulted in 652 articles of which 304 were screened based on title and abstracts. Ninety-one of the screened articles were then selected for full-text assessment resulting in 42 articles for in-depth analysis. RESULTS The literature review identified nine enabling and hindering factors relevant for adherence to asthma treatment among adolescents: behavior, belief, self-management, health literacy, role of health provider, assessment of adherence, role of caregiver, role of peers and the national asthma guidelines. CONCLUSION Working with this particular age group is complex and further research in understanding adolescent's behavior, motives, beliefs and perceptions towards adherence to asthma treatment is required to guide them towards better self-management and acceptance of their condition.
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Affiliation(s)
- Anam Ahmad
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
| | - Kristine Sorensen
- a Department of International Health , CAPHRI, Faculty of Health Medicine and Life Science, Maastricht University , Maastricht , The Netherlands
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19
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McGrady ME, Brown GA, Pai ALH. Medication adherence decision-making among adolescents and young adults with cancer. Eur J Oncol Nurs 2015; 20:207-14. [PMID: 26372619 DOI: 10.1016/j.ejon.2015.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/05/2015] [Accepted: 08/31/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE Nearly half of all adolescents and young adults (AYAs) with cancer struggle to adhere to oral chemotherapy or antibiotic prophylactic medication included in treatment protocols. The mechanisms that drive non-adherence remain unknown, leaving health care providers with few strategies to improve adherence among their patients. The purpose of this study was to use qualitative methods to investigate the mechanisms that drive the daily adherence decision-making process among AYAs with cancer. METHODS Twelve AYAs (ages 15-31) with cancer who had a current medication regimen that included oral chemotherapy or antibiotic prophylactic medication participated in this study. Adolescents and young adults completed a semi-structured interview and a card sorting task to elucidate the themes that impact adherence decision-making. Interviews were transcribed verbatim and coded twice by two independent raters to identify key themes and develop an overarching theoretical framework. RESULTS Adolescents and young adults with cancer described adherence decision-making as a complex, multi-dimensional process influenced by personal goals and values, knowledge, skills, and environmental and social factors. Themes were generally consistent across medication regimens but differed with age, with older AYAs discussing long-term impacts and receiving physical support from their caregivers more than younger AYAs. CONCLUSIONS The mechanisms that drive daily adherence decision-making among AYAs with cancer are consistent with those described in empirically-supported models of adherence among adults with other chronic medical conditions. These mechanisms offer several modifiable targets for health care providers striving to improve adherence among this vulnerable population.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
| | - Gabriella A Brown
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, MLC 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
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20
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Mowrer JL, Tapp H, Ludden T, Kuhn L, Taylor Y, Courtlandt C, Alkhazraji T, Reeves K, Steuerwald M, Andrew M, Dulin M. Patients' and providers' perceptions of asthma and asthma care: a qualitative study. J Asthma 2015; 52:949-56. [PMID: 25975701 DOI: 10.3109/02770903.2015.1010731] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Differences in patients' and providers' perceptions of asthma and asthma care can create barriers to successful treatment. The primary goal of this qualitative study was to further explore patient and provider perceptions of asthma and asthma care as part of a larger Asthma Comparative Effectiveness Study. METHODS Focus groups held every 6 months for 3 years were designed to have a mix of both patients and providers allowing for unique understanding around asthma care. RESULTS The discussion centered on goal setting, asthma action plans and prevention strategies for asthma exacerbations. Three overarching themes, with a variety of subthemes, emerged as the main findings of this study. The three main themes were Cost/Economic Barriers/Process, Self-Governance/Adherence and Education. CONCLUSIONS These themes indicated a strong need for patient educational interventions around asthma as well as education for providers around cost, insurance coverage and patient-centered communication. Specifically, education on learning to use inhalers properly, avoiding triggers and understanding the importance of a controller medication will benefit patients in the long-term management of asthma.
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Affiliation(s)
- J Lauren Mowrer
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Hazel Tapp
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Thomas Ludden
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Lindsay Kuhn
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Yhenneko Taylor
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Cheryl Courtlandt
- c Department of Pediatrics , Carolinas HealthCare System , Charlotte , NC , USA , and
| | - Tami Alkhazraji
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
| | - Kelly Reeves
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | | | - McWilliams Andrew
- b Family Medicine Research, Carolinas HealthCare System , Charlotte , NC , USA
| | - Michael Dulin
- a Dickson Advanced Analytics, Carolinas HealthCare System , Charlotte , NC , USA
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Abstract
Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA,
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Koster ES, Philbert D, Winters NA, Bouvy ML. Adolescents' inhaled corticosteroid adherence: the importance of treatment perceptions and medication knowledge. J Asthma 2014; 52:431-6. [PMID: 25340444 DOI: 10.3109/02770903.2014.979366] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Ellen S Koster
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Pharmacy Practice Network for Education and Research (UPPER), Utrecht Institute of Pharmaceutical Sciences, Utrecht University , Utrecht , The Netherlands
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Koster ES, Philbert D, Winters NA, Bouvy ML. Medication adherence in adolescents in current practice: community pharmacy staff's opinions. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:221-4. [PMID: 25047137 DOI: 10.1111/ijpp.12137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore pharmacy staff's perspectives regarding medication use behaviour in adolescent patients. METHODS Structured face-to-face interviews were conducted with 170 community pharmacy staff members. KEY FINDINGS Medication-related problems in adolescents had been experienced by 80 respondents; non-adherence was frequently mentioned (n = 73). An important reason for medication-related problems in adolescents not being recognised was that prescriptions are often collected by the parents (with or without the teenager). Solutions suggested by the interviewees to improve adolescents' medication use behaviour included (improving) counselling with emphasis on necessity/benefits of medication (n = 130) and more direct contact with adolescents instead of parent(s) (n = 77). Use of digital media for educational purposes or reminder services was suggested to support medication use (n = 67). CONCLUSIONS Almost half of pharmacy staff experienced problems related to medication use in adolescents. Pharmacy staff see a primary role for counselling on the benefits of therapy but foresee difficulties in obtaining direct contact with adolescents. Use of new media could be useful.
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Affiliation(s)
- Ellen S Koster
- Utrecht Pharmacy Practice Network for Education and Research, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Abstract
The adolescent with asthma experiences a period of physical and psychosocial changes that affect their health and well-being. Overall, adolescents with asthma are at increased risk for asthma morbidity and death. Increased rates of depression and anxiety, for the adolescent and their caregivers, can lead to non-adherence to their medical regimens, poor symptom control, and poor treatment outcomes. Contextual factors, such as race, ethnicity, and living situation, affect the prevalence, morbidity, and mortality for the adolescent with asthma. These factors also affect the transition process for adolescents entering adult medical care. An overview is presented of how the adolescent with asthma differs and how healthcare providers can promote effective asthma management and better asthma control.
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Affiliation(s)
- Matthew J Bitsko
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA; Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA.
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Bruce K Rubin
- Children's Hospital of Richmond at VCU, Richmond, VA 23298, USA; Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
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Naimi I, Apter AJ, Ginsburg K, Naimi DR. Evaluating the adolescent with asthma: are we doing enough? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:230-2. [PMID: 24607056 DOI: 10.1016/j.jaip.2013.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/06/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Iman Naimi
- St George's University School of Medicine, Grenada, West Indies
| | - Andrea J Apter
- Pulmonary, Allergy & Critical Care Division, University of Pennsylvania, Philadelphia, Pa
| | - Kenneth Ginsburg
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - David R Naimi
- Northwest Asthma & Allergy Center and University of Washington, Seattle, Wash.
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Hanghøj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. J Adolesc Health 2014; 54:121-38. [PMID: 24182940 DOI: 10.1016/j.jadohealth.2013.08.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions. METHODS A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach. RESULTS Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases. CONCLUSION Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment.
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Affiliation(s)
- Signe Hanghøj
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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