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APHA Scientific Session and Event Listing

Recorded presentation

Barbara G. Bokhour, PhD¹, Ellen S. Cohn, ScD², Dharma Cortes, PhD³, Leanne S. Yinusa-Nyahkoon, MS², Lauren Smith, MD, MPH⁴, and Tracy Lieu, MD, MPH⁵. (1) Health Services/ Center for Health Quality, Outcomes & Economic Research, Boston University School of Public Health, ENRM Veterans Hospital, 200 Springs Road (152), Bedford, MA 01742, 781-687-2862, bokhour@bu.edu, (2) Dept. of Occupational Therapy and Rehabilitation Counseling, Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, (3) Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, (4) Pediatrics, Boston University School of Medicine/ Boston Medical Center, 91 E. Concord Street, Maternity Building, 4th Floor, Boston, MA 02118, (5) Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215

Asthma affects more than 4 million children in the US making it a leading cause of childhood morbidity. Scientific evidence and national guidelines support the use of daily inhaled anti-inflammatory medications among children with persistent asthma. However, fewer than half of all children with persistent asthma use these controller medications, and controller use is even less likely among African-American and Latino children. The underlying reasons for this disparity are not well understood. This study examines parents' reported approaches to medications for managing their children's asthma and associated explanatory models of asthma. 44 parents of children, age 5-12 with a diagnosis of persistent asthma, and self-identified as African-American, Latino, or Caucasian participated in 1 ½ hour semi-structured interviews. Participants were recruited in the pediatric clinics of a large inner-city medical center, a multi-specialty provider group, and a community health center. Interviews focused on families' social and economic context, their experience of living with a child with asthma, explanatory models of asthma, interactions with providers, asthma management routines and medication use. An investigator who was the same race/ethnicity as the participant conducted the interview, and Latino participants were interviewed in Spanish when requested. All interviews were transcribed verbatim by a professional transcription service. Five investigators conducted detailed qualitative analysis using sociolinguistic analysis and thematic analysis with a grounded theory structure. Based on the parents' reports, findings revealed four ways in which parents approached giving their children medication relative to provider recommendations: 1) congruence, parents gave medications as prescribed by their provider, 2) inadvertent non-congruence, parents believed they were giving medications as prescribed, but were not, 3) contextual non-congruence, parents were intent on giving medications as prescribed but were unable to do so, and 4) intentional non-congruence, parents intentionally did not give medications as prescribed. We also identified two major explanatory models of asthma: 1) Chronic model, parents believed that their child had asthma all the time and 2) Intermittent model, parents believed their children got asthma sometimes, but did not always have the disease. We discuss the relationship between parents' reported approaches to asthma medication use and explanatory models, parents' perceptions of predictability and severity, social contextual factors, and racial/ethnic background. We discuss the implications of our findings for parent-provider communication and for the design of effective interventions to improve parent management of their children's asthma, and to reduce disparities in asthma outcomes.

Learning Objectives: At the conlcusion of the session, the participantwill be able to

• Recognize different explanatory models of asthma.
• Describe different approaches parents use to giving medications for child asthma.
• Identify factors that may contribute to different parent approaches to asthma management.

Keywords: Asthma, Health Disparities

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation