Conn KM, Halterman JS, Lynch K, Cabana MD. The impact of parents' medication beliefs on asthma management

Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Golisano Children's Hospital at Strong, Rochester, New York 14642, USA.
PEDIATRICS (Impact Factor: 5.47). 10/2007; 120(3):e521-6. DOI: 10.1542/peds.2006-3023
Source: PubMed

ABSTRACT Previous studies suggest a relationship between parental beliefs about asthma medications and medication adherence. It is not clear how parents' positive and negative feelings about medications interact to influence medication adherence.
The objectives of this study were to describe parents' perceived need for and concerns about their child's asthma medications and to assess the weighted impact of these positive and negative beliefs on parent-reported adherence.
We conducted a cross-sectional survey of parents of children with asthma in southeast Michigan; response rate was 71%. Children with reported use of a preventive asthma medication were included (n = 622). We used a validated Beliefs About Medications Questionnaire (2 subscales: necessity and concern) to assess parents' positive and negative attitudes about their child's medications. To measure how parents weigh these beliefs, we also calculated a necessity-concern differential score (difference between necessity and concern subscales). We used a 4-item parent-report scale to measure medication adherence.
The majority of children were nonminority. Overall, 72% of parents felt that their child's asthma medications were necessary, and 30% had strong concerns about the medications. For 77% of parents, necessity scores were higher than concern scores, and for 17%, concern exceeded necessity. Nonminority parents were more likely to have necessity scores exceed concern scores compared with minority parents (79% vs 68%). Mean adherence scores increased as the necessity-concern differential increased. In a multivariate mixed-model regression, a greater necessity-concern differential score and being nonminority predicted better adherence.
These findings confirm a relationship between medication beliefs and adherence among parents of children with asthma. A better understanding of parents' medication beliefs and their impact on adherence may help clinicians counsel effectively to promote adherence.

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Available from: Kelly M Conn, Sep 27, 2015
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    • "These include the Belief about Medicines Questionnaire (BMQ),6 the Beliefs and Behaviour Questionnaire,7 the Adherence Estimator,8 and ASK-20.9 The most widely used, the BMQ, is based on a necessity–concerns framework, whereby patients with a high “necessity” score and low “concerns” score are more likely to be adherent.10–13 Other studies have demonstrated that a high “concerns” score and a low “necessity” score is likely to result in low adherence.14–19 "
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    ABSTRACT: Beliefs about medicines impact on adherence, but eliciting core beliefs about medicines in individual patients is difficult. One method that has the potential to elicit individual core beliefs is the "repertory grid technique." This study utilized the repertory grid technique to elicit individuals' beliefs about their heart failure treatment and to investigate whether generated constructs were different between adherent and nonadherent patients. Ninety-two patients with heart failure were interviewed using a structured questionnaire that applied the repertory grid technique. Patients were asked to compare and contrast their medicines and self-care activities for their heart failure. This lead to the generation of individual constructs (perceptions towards medicines), and from these, beliefs were elicited about their heart failure treatment, resulting in the generation of a repertory grid. Adherence was measured using the Medication Adherence Report Scale (MARS). Patients with a MARS score ≥ 23 were categorized as "adherent" and those with a score ≤ 22 as "nonadherent." The generated grids were analyzed descriptively and constructs from all grids themed and the frequency of these constructs compared between adherent and nonadherent patients. Individual grids provided insight into the different beliefs that patients held about their heart failure treatment. The themed constructs "related to water," "affect the heart," "related to weight," and "benefit to the heart" occurred more frequently in adherent patients compared with nonadherent patients. The repertory grid technique elicited beliefs of individual participants about the treatment of their heart failure. Constructs from self-reported adherent patients were more likely to reflect that their medicines and self-care activities were related to water and weight, and affect and benefit to the heart. Providing clinicians with better insight into individuals' beliefs about their treatment may facilitate the development of tailored interventions to improve adherence.
    Patient Preference and Adherence 02/2013; 7:141-50. DOI:10.2147/PPA.S40725 · 1.68 Impact Factor
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    • "Furthermore, children whose parents have positive beliefs about the benefits of asthma management behaviours are less likely to experience wheezing and have better general health (Wade et al., 2000). Lower parental expectations of treatment benefits, along with fears about the potential harm caused by medications, have been shown to predict non-adherence (Yoos et al., 2003) and for some parents these concerns can even outweigh the perceived necessity of these medications (Conn et al., 2007). "
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    ABSTRACT: The aim of this study was to explore parents' attributions for their children's behaviour and their beliefs about treatment efficacy, and to investigate the specific topics and strategies parents believe would be most beneficial in a parenting intervention. A survey of 165 parents and qualitative interviews with 13 parents were conducted, assessing child behaviour, parental attributions and intervention characteristics. The findings indicated that parents were confident in their ability to manage the challenges of asthma, and in general, believed that five key asthma treatment recommendations were at least moderately helpful in managing their child's asthma. Many parents believed that asthma medications were related to behavioural difficulties including hyperactivity, disruptiveness, and disobedience. Nearly half of the parents were concerned about how to best manage their child's asthma, and a number of themes were identified as important intervention elements. The implications of these findings for intervention development are discussed.
    Journal of Child Health Care 03/2012; 16(1):75-90. DOI:10.1177/1367493511426278 · 0.88 Impact Factor
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    • "Consequently, although ICS represent the cornerstone of anti-inflammatory therapy of asthma, many paediatricians are still concerned about the potential adverse effects of long-term administration of these agents, particularly on children's growth. Along the same lines, parental beliefs on ICS also impact on patient adherence to long-term treatment with these agents (Conn et al., 2007). This chapter presents up-to-date information on the effects of asthma per se as well as of ICS on linear growth of children and highlights the current knowledge on the interaction of the effects of ICS on growth and the HPA axis. "
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    ABSTRACT: Chronic illness per se, including asthma, may cause retardation of linear growth and this confounding factor is often difficult to separate from the potential stunting effect of inhaled corticosteroids (ICS) on children’s height. It has been proposed that the vast majority of asthmatic children will attain a normal adult height, and that most perceived growth failure is due to pubertal delay. Long-term treatment with ICS has profound effects on bone metabolism and linear growth. These effects are sensitive and specific and may represent an evolutionary adaptation in order to redirect resources during physiologic stress. It appears that any impairment of linear growth velocity in these children is likely to be reversible and of short duration. Although the deceleration of linear growth is widely accepted as amarker of the systemic effects of ICS, recent observational studies have reported that satisfactory growth does not exclude the possibility of adrenal suppression. Various polymorphisms in the glucocorticoid receptor could be related to the susceptibility to glucocorticoid-induced side effects. This chapter presents cutting-edge information of the effects of asthma per se as well as of ICS on linear growth of children and highlights the current knowledge on the interactions between this effect and that on the hypothalamic-pituitary-adrenal axis.
    Handbook of Growth and Growth Monitoring in Health and Disease, 1rst edited by V.R. Preedy, 01/2012: chapter Growth in Asthmatic Children: pages 1755-1762; Springer Science+Business Media.
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