Beliefs about medications in asthmatic children presenting to emergency department and their parents

The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review

Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.

Characteristics of inpatients with atopic asthma in a tertiary center: Do age and gender have an influence?

Background: Several studies have demonstrated gender influence on asthma prevalence, being higher among males during early childhood. Little is known about the impact of gender and age on asthma exacerbation characteristics in pediatrics. This study aimed to determine the differences in acute asthma between males and females in three different age groups regarding perinatal characteristics of asthmatic patients, comorbidities, medication adherence, level of blood eosinophils, and pattern of hospitalization.Methods: The medical records of 130 pediatric patients with asthma, who presented to the emergency department at Jordan University hospital with asthma exacerbations, were retrospectively reviewed. Demographic information and clinical characteristics were collected.Results: The mean age of patients was 10.7±4.7 years. The age at diagnosis and gestational age were significantly higher in older children. Furthermore, younger children were significantly more likely to experience winter exacerbations and more emergency presentations. Male patients were considerably younger than their female counterparts and were diagnosed younger. In addition, male patients were more likely to have eosinophil levels higher than 3% than female patients.Conclusion: Gender plays a role in the development and outcome of asthma exacerbations at different ages of pediatrics. A better understanding of gender-based and age-based differences in asthma dictates a personalized approach to treatment.

Effects of an Asthma Education Camp Program on Quality of Life and Asthma Control among Thai Children with Asthma: A Quasi-Experimental Study

Caregiver knowledge and management ability can improve asthma control and quality of life (QoL) among children with asthma. A quasi-experimental study was proposed to assess the effect of a 1 day educational camp program on the QoL of children with asthma and on their caregivers’ asthma knowledge and management. Children with asthma and their caregivers were invited to attend a camp. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Childhood Asthma Control Test score, and forced expiratory volume in 1 s were assessed in children at the first, 3 month, 6 month, and 1 year visits. The caregiver’s knowledge, attitudes, and practice (KAP) survey was assessed at each visit. A total of 212 patients were enrolled (mean age: 8.56 ± 1.63 years) but only 72 patients attended the camp. There was no significant difference in baseline characteristics, asthma severity, or asthma risk factors between camp attendees and non-attendees. The KAP of caregivers who attended the camp was significantly higher than non-attendees at the 3 month and 6 month visits (16.86 ± 2.3 vs. 15.95 ± 2.78 (p = 0.009); 17.25 ± 2.22 vs. 16.7 ± 2.68 (p = 0.04)). QoL did not significantly differ between patient attendees vs. non-attendees. PAQLQ mean score correlated with asthma control, indicating that patients with well-controlled asthma had better QoL than those with unstable asthma control (p < 0.001). An asthma education camp can help increase self-management knowledge, even though its effect may be short-term. Integrating asthma education into routine care could enhance asthma management in children.

Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review

INTRODUCTION

Nonadherence to inhaled corticosteroids (ICSs) in children with asthma leads to significant morbidity and mortality. Few adherence interventions have been effective and little is known about what contributes to intervention effectiveness. This systematic review summarizes the efficacy and the characteristics of effective interventions.

METHODS

Six databases were systematically searched on October 3, 2020 for randomized control trials measuring adherence to ICS in children with asthma. A narrative synthesis was conducted focusing on intervention efficacy and study reliability. Intervention content was coded based on the National Institute for Health and Care Excellence guidelines for medicines adherence (the Perceptions and Practicalities Approach, PAPA) and behavior change techniques (BCTs), to determine the effective aspects of the intervention.

RESULTS

Of 240 studies identified, 25 were eligible for inclusion. Thirteen of the 25 studies were categorized as being highly reliable. Nine of the 13 interventions were effective at increasing adherence and 6 of those met the criteria for a PAPA intervention. Techniques targeting perceptions and practicalities in successful interventions included rewards, reminders, feedback and monitoring of adherence, pharmacological support, instruction on how to take their ICS/adhere, and information about triggers for symptoms and nonadherence.

CONCLUSION

Adherence interventions in children with asthma have mixed effectiveness. Effective intervention studies were more frequently of higher quality, were tailored to individuals' perceptual and practical adherence barriers, and used multiple BCTs. However, due to the small number of included studies and varying study design quality, conclusions drawn here are preliminary. Future research is needed to test a PAPA-based intervention with a rigorous study design.

Improving Asthma Care Together (IMPACT) mobile health intervention for school-age children with asthma and their parents: a pilot randomised controlled trial study protocol

INTRODUCTION

Asthma is an incurable, lifelong condition that places children at increased risk for exacerbation, hospitalisation and school absences. Most paediatric asthma interventions target parents alone and are overly prescriptive. Improving Asthma Care Together (IMPACT) is a novel shared management system comprised of a mobile health (mHealth) application, symptom watch and tailored health intervention that pairs parent and child together as an asthma management team. IMPACT helps families monitor asthma status, tailor asthma management strategies and facilitate intentional transition of asthma management to the child. The purpose of this study is to determine the feasibility, acceptability and preliminary efficacy of the IMPACT intervention.

METHODS AND ANALYSIS

This pilot randomised controlled trial will recruit 60 children with asthma (7-11 years) and one parent. All parent-child dyads will complete data collection sessions at baseline, postintervention and follow-up. Dyads randomised to the intervention group (IMPACT) will complete the 8-week intervention comprised of weekly activities including symptom monitoring, goal setting and progress monitoring. Dyads randomised to the control group will receive usual care but then be provided access to IMPACT at the end of the study. Feasibility will be measured by the proportion of eligible dyads enrolled and retained. Acceptability of IMPACT will be assessed using the Acceptability of Intervention Measure, the System Usability Scale and a semistructured interview. Preliminary efficacy is determined based on change in primary outcomes, parent-reported and child-reported asthma responsibility and asthma self-efficacy scores, from baseline.

ETHICS AND DISSEMINATION

This study has been approved by the University of Washington Institutional Review Board; study ID: STUDY00010461. Participants gave informed consent to participate in the study before taking part. Study results will be disseminated in peer-reviewed journals and scientific conferences. A lay summary will be provided to study participants.

TRIAL REGISTRATION NUMBER

NCT04908384 (ClinicalTrials.gov identifier).

Association between Adverse Effects and Parental Beliefs about Antiepileptic Medicines

Background and Aim: Adverse effects are common in children treated with antiepileptic medications and may affect parental beliefs about treatment. The aim of the study was to investigate the relationship between adverse effects and parental beliefs about antiepileptic drugs used for the treatment of their children. Methods: The study was performed at the University Children’s Hospital, Belgrade, Serbia from 2013–2015. Parents of children treated with valproic acid, carbamazepine or lamotrigine, were eligible. They were asked to fill in the Beliefs about Medications Questionnaire (BMQ) and The Liverpool Adverse Events Profile (LAEP). Results: Parents of 127 children (average age 9.88 ± 4.16 years) of whom 111 had epilepsy (67 generalized, 44 focal) and 16 with febrile seizures participated in the study. Nervousness and/or agitation, weight gain, restlessness, headache, difficulty in concentrating, feeling of aggression and upset stomach were most frequent adverse effects, reported in 37% of the population. BMQ-specific necessity scores significantly correlated with parental education; parents with elementary school showed lower scores than those with higher education. The presence of difficulty in concentrating of their child was associated with higher BMQ concern scores (20.73 ± 4.25 vs. 18.99 ± 3.60, p = 0.043) as well as necessity scores (18.42 ± 3.31 vs. 16.40 ± 2.73, p = 0.017). Higher scores of BMQ-general overuse were reported in the presence of a headache (8.79 ± 2.81 vs. 7.64 ± 2.72, p = 0.027). Conclusions: The main finding of our study is that parental beliefs about antiepileptic drugs were associated with the presence of adverse effects. Understanding this relationship could allow physicians and pharmacists to structure better educational programs for parents of children treated with antiepileptic drugs. Education should be more focused towards understanding the adverse effects of antiepileptics which could alleviate parental concerns and strengthen their beliefs about the necessity of medication use in their children.

Very Poorly Controlled Asthma in Urban Minority Children: Lessons Learned

BACKGROUND

Very poorly controlled (VPC) asthma in children is associated with ongoing acute exacerbations but factors associated with VPC are understudied.

OBJECTIVE

To examine the risk factors associated with VPC asthma in urban minority children.

METHODS

This descriptive study examined asthma control levels (well-controlled [WC], not well-controlled [NWC], and VPC) at baseline and 6 months in children participating in an ongoing randomized controlled trial of an emergency department/home environmental control intervention. Data collection occurred during the index emergency department visit and included allergen-specific IgE and salivary cotinine testing and caregiver interview of sociodemographic and child health characteristics. Follow-up data were collected at 6 months. Unadjusted analyses examined the association of sociodemographic and health characteristics by level of asthma control. Multivariate analysis tested significant factors associated with VPC asthma at 6 months.

RESULTS

At baseline most children were categorized with VPC asthma (WC, 0%; NWC, 47%; VPC, 53%) and rates of VPC minimally improved at 6 months (WC, 13%; NWC, 41%; VPC, 46%). Risk for VPC asthma was twice as likely in children with allergic rhinitis (odds ratio [OR], 2.42), having 2 or more primary care provider asthma visits within the past 3 months (OR, 2.77), or caregiver worry about medication side effects (OR, 2.13) and 3 to 4 times more likely when asthma control was assessed during the fall or spring season (OR: fall, 3.32; spring, 4.14).

CONCLUSIONS

Improving asthma control in low-income, high-risk children with VPC asthma requires treatment of comorbidities, attention to caregiver medication beliefs, and adept use of stepwise therapy.

Knowledge and practice of parents and guardians about childhood asthma at King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia

Background

Family management of asthmatic children is affected by several factors, primarily the parent’s knowledge and attitude toward asthma.

Objective

The aim of this study was to explore the knowledge and practice of parents and guardians about asthma in their children.

Methods

Two hundred and thirty-one self-administered questionnaires were distributed to parents and guardians attending, with their children, general pediatric and pediatric pulmonology outpatient clinics at King Abdullah Specialist Children’s Hospital, King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia, during the period from August 2016 to March 2017.

Results

Most of the participants (79.6%) have moderate knowledge. The mean of total knowledge was found to be higher among mothers compared with other groups (p=0.019). Most participants (88.3%) reported providing asthma treatment regularly and 61.9% visited the clinic regularly. Almost half of the participants have misconceptions about asthma medications. During acute asthma attacks, more than half of the participants (54.5%) massaged their child’s chest or back, and 52.4% provided the child homemade or herbal remedies.

Conclusion

This study revealed a moderate level of knowledge about asthma among the parents and guardians of asthmatic children, but poor knowledge about asthma medications. For better control of asthma, more effort is needed to educate caregivers and to enhance their awareness about asthma and highlight the misconceptions about asthma medications at both hospital level and community level.

Exploring the intersection of executive function and medication adherence in school-age children with asthma

Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma.

OBJECTIVE

The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma.

METHODS

Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning.

RESULTS

Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = -3.84, p =. 001, and shifting, t (30) = -3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence.

CONCLUSIONS

This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.

Beliefs about hydroxyurea in youth with sickle cell disease

BACKGROUND

Hydroxyurea reduces complications and improves health-related quality of life (HRQOL) in sickle cell disease (SCD) patients, however adherence remains suboptimal. Understanding patients' views of hydroxyurea is critical to optimize adherence, particularly in adolescents and young adults (AYA). Study objectives were to assess beliefs about hydroxyurea using the Beliefs about Medicines Questionnaire (BMQ), and to examine the relationship of patients' beliefs to their hydroxyurea adherence and HRQOL.

METHODS

Thirty-four AYA with SCD participated in a cross-sectional study January-December 2015. Study assessments included BMQ to examine beliefs about hydroxyurea; Visual Analogue Scale (VAS) to assess hydroxyurea adherence; and Patient Reported Outcomes Measurement Information System (PROMIS®) to evaluate HRQOL.

RESULTS

Participants (41% female, 91% Black) had median age of 13.5 (IQR 12-18) years. Participants' concerns about overuse of medications correlated with concerns about hydroxyurea (r_s = 0.36, p = 0.04) and overall harm of medications (r_s = 0.5, p = 0.003). Participants' age positively correlated with the necessity of hydroxyurea (r_s = 0.45, p = 0.007). Participants' concerns about hydroxyurea and overuse of medications positively correlated with anxiety (r_s = 0.41, p = 0.02; r_s = 0.44, p = 0.01) and depression (r_s = 0.37, p = 0.04; r_s = 0.54, p = 0.001), but inversely correlated with peer relationships (r_s = -0.45, p = 0.03; r_s = -0.44, p = 0.03), respectively, suggesting better HRQOL with concerns. Fifty percent of participants reported low hydroxyurea adherence (VAS < 80%), which was more seen in patients with higher concerns about hydroxyurea (p = 0.02).

CONCLUSIONS

Beliefs about hydroxyurea correlated with HRQOL scores and adherence levels. Addressing patients' concern about hydroxyurea and medications overall as well as routine assessment of adherence and beliefs could help to overcome adherence barriers.

Association of Asthma Illness Representations and Reported Controller Medication Adherence Among School-Aged Children and Their Parents

This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6-11 years) with persistent asthma and their parents. Thirty-four parent-child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = -.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.

Pediatric-to-adult Transition and Medication Adherence in Patients with Inflammatory Bowel Disease

BACKGROUND

Medication nonadherence is common in inflammatory bowel disease and is associated with poor outcomes. There has been no study on pediatric-to-adult transition as a risk factor for nonadherence in inflammatory bowel disease, which has been demonstrated in other diseases. We aimed to assess whether transitioned (TR) patients have higher nonadherence rates than young adults (YAs) diagnosed in adulthood.

METHODS

Consecutive ambulatory subjects were prospectively recruited and completed the validated Medication Adherence Reporting Scale (MARS), with the primary outcome being adherence differences between group age-matched TR and YA groups. Pediatric subjects were taken as the control group. Perceptions of medication-related necessity and concerns were assessed with the Beliefs about Medicines Questionnaire (BMQ). Nonadherers (defined as MARS ≤16) received the Inflammatory Bowel Diseases Pharmacist Adherence Counselling (IPAC) intervention and adherence change was reassessed after 6 months as a secondary outcome.

RESULTS

Adherence in TR patients (n = 38, mean age 20.4, 13.2% nonadherent) was noninferior to and numerically better than YAs diagnosed in adulthood (n = 41, mean age 21.2, 24.4%). Nonadherence in the pediatric control group (n = 50, mean age 14.7) was 8.0%. YAs had significantly higher medication-related concerns (14.6 versus 11.9, P = 0.02) than the pediatric group. The IPAC intervention reduced nonadherence rates by 60% (P = 0.004).

CONCLUSIONS

TR patients did not have worse adherence than YAs diagnosed in adulthood. Protective factors may include previous treatment in pediatric centers and the salient symptomatology of inflammatory bowel disease, whereas increasing concerns over medications contribute to nonadherence in YAs. Pharmacist-led counselling improves adherence in these patients.

Factors associated with poor controller medication use in children with high asthma emergency department use

BACKGROUND

Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community.

OBJECTIVE

To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use.

METHODS

Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention. Logistic regression was used to examine factors associated with an AMR greater than 0.50, reflecting appropriate controller medication use.

RESULTS

Most children were male (64%), African American (93%), Medicaid insured (93%), and classified as having uncontrolled asthma (44%). Almost half (48%) received non-guideline-based care or low controller medication use based on an AMR less than 0.50. The final regression model predicting an AMR greater than 0.50 indicated that children receiving specialty care (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.06-11.50), caregivers reporting minimal worry about medication adverse effects (OR, 0.50; 95% CI, 0.25-1.00), positive sensitization to ragweed allergen (OR, 3.82; 95% CI, 1.63-8.96), and negative specific IgE for dust mite (OR, 0.33; 95% CI, 0.15-0.76) were significantly associated with achieving an AMR greater than 0.50.

CONCLUSION

Clinical decision making for high-risk children with asthma may be enhanced by identification of sensitization to environmental allergens, ascertaining caregiver's concerns about controller medication adverse effects and increased referral to specialty care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01981564.

Caregiver knowledge and its relationship to asthma control among children in Saudi Arabia

OBJECTIVE

The objective of this study was to examine caregiver responses to individual questions of the asthma knowledge questionnaire and to compare the prevalence of uncontrolled asthma among children according to caregiver responses (correct vs. incorrect).

METHODS

We conducted an analytical cross-sectional study among 158 children with asthma aged 4-11 who were attending the pediatric primary care clinic of the King Khalid University Hospital in Riyadh, Saudi Arabia. The asthma knowledge questionnaire for use with parents or guardians of children with asthma was used to measure the knowledge of caregivers. Asthma control in the children was measured using an Arabic version of the childhood asthma control test. Pearson's chi-square or Fisher's exact tests were used to compare the prevalence of uncontrolled asthma according to the caregivers' responses.

RESULTS

This study showed substantial gaps in knowledge among caregivers of children with asthma. The answer to only one of 17 questions was well known (86.1%); this question involved the harm of smoking near a child with asthma. Answers on 11 of 17 questions were significantly (p < 0.05) associated with asthma control in children. Among the key questions explored, the prevalence of uncontrolled asthma was 3.0 (1.8-4.9), 2.5 (95% confidence interval = 1.7-3.9) and 1.8 (1.3-2.5) times higher among children of caregivers who did not disagree with the statements that it is not good for children to use an inhaler for too long, that inhalers can affect or damage the heart, and that children with asthma should use asthma medications only when they have symptoms.

CONCLUSIONS

Although innovations are needed to help patients improve their adherence to treatment and to effectively utilize the benefits of contemporary asthma medications, we observe substantial knowledge-related problems in the asthma management of children in Saudi Arabia.

Determinants of asthma control among children in Saudi Arabia

OBJECTIVE

Asthma is the most common chronic disease among children. Uncontrolled asthma may considerably decrease the quality of life for patients and their families. Our objective was to identify possible risk factors for poor asthma control in children.

METHODS

A cross-sectional study was conducted among children with asthma aged 4-11 years who attended a pediatric clinic for follow-up visits at one of the major teaching hospitals in Riyadh, Saudi Arabia. Asthma control status was measured by the childhood asthma control test. Multiple logistic regression analysis was performed to explore the relationships between the outcome and exposure variables.

RESULTS

Uncontrolled asthma was present in 89 out of 158 children (59.3%). Asthma control improved with the number of siblings. Control improved by 69% with two or three siblings (OR = 0.31, 95% CI = 0.10-0.96) and by 87% with four or more siblings (OR = 0.13, 95% CI = 0.04-0.48). Similarly, asthma control improved with an increased asthma knowledge of the caregiver (OR = 0.87, 95% CI = 0.81-0.93). Household incomes less than SAR 15 000 and sharing a bedroom increased the odds of having uncontrolled asthma by 2.30 (95% CI = 1.02-5.21) and 3.33 (95% CI = 1.33-8.35), respectively.

CONCLUSIONS

In addition to knowledge, socioeconomic factors, such as family income, household crowding, and the number of siblings are associated with asthma control among children in Saudi Arabia. Further research is needed to investigate the role of these factors.

The knowledge, attitudes and practices of parents of children with asthma in 29 cities of China: a multi-center study

BACKGROUND

Asthma is becoming increasingly prevalent among children in China. Poor parent knowledge and attitudes often contribute to inappropriate management practices, leading to deficiencies in the care process. We aimed to document the knowledge, attitudes and practices (KAP) of parents of children with asthma and analyze how knowledge and attitudes relate to practices. Our secondary objective was to identify the factors associated with parent KAP scores.

METHODS

A KAP questionnaire was distributed to parents caring for 2960 children (0-14 years) diagnosed with asthma for at least 3 months from China's 29 provinces. A 50-item questionnaire was devised for this cross-sectional survey based on a comprehensive review of the subject. Questionnaires were scored on 30 items regarding parent asthma-related KAP, with one point for every correct response and a possible range of 0-13 for knowledge, 0-7 for attitudes and 0-10 for practices. Higher scores indicated better KAP. Chi-squared tests and logistic regression were used to identify factors associated with practices and combined KAP scores.

RESULTS

The response rate was 83.95% (2485/2960). Only 18.31% (455/2485) of parents correctly answered ≥ 60% of the knowledge questions (mean = 5.69). Most (89.85%; 2226/2485) gave positive responses to ≥ 60% of the attitude questions (mean = 5.23) while 67.89% (1687/2485) correctly answered ≥ 60% of the practices questions (mean = 6.19). Knowledge and attitudes were positively associated with pulmonary function testing, regular physician visits, monitoring with a peak flow meter and the Children's Asthma Control Test questionnaire, avoidance of asthma triggers, using an inhaled β2 receptor agonist and adherence to medication regimen (p ≤ 0.05). Attitudes were also associated with allergen testing. In logistic regression analysis, high KAP scores (dichotomized by a cut-off score of 18) were positively associated with food allergy, rhinitis, physician visits, frequency of visits and parent education (p < 0.05, OR > 1).

CONCLUSIONS

Generally, the parents' KAP were poor. A gap between recommended and actual practice was observed, which may be related to inadequate knowledge about and poor attitudes toward childhood asthma. Improving knowledge and attitudes may encourage better practices among parents of children with asthma.