Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Dharma Cortes, PhD¹, Barbara G. Bokhour, PhD², Ellen S. Cohn, ScD³, and Leanne S. Yinusa-Nyahkoon, MS³. (1) Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, 781-321-1038, decortes@aol.com, (2) 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, (3) Dept. of Occupational Therapy and Rehabilitation Counseling, Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215

Asthma, a common chronic childhood disease, is considered a national epidemic and affects 4.4 million children in the U.S. Scientific evidence and national guidelines support the use of daily inhaled anti-inflammatory medications among children with persistent asthma. It is estimated that fewer than half of all children with persistent asthma use preventive medications as prescribed. However, when we look at use of preventive medication by race and ethnicity, Black and Latino children with asthma are both more likely to underuse preventive medications and to experience adverse outcomes compared to their white peers. Some have suggested that parents' beliefs about asthma might explain underuse of preventive medication. Others have pointed to patient-provider communication issues as potential factors contributing to medication underuse. This study examined approaches to medications for managing their children's asthma and associated explanatory models of asthma as reported by 44 parents of children, ages 5-12 with a diagnosis of persistent asthma. The sample included African-American, Latino, and Caucasian parents, all of whom consented to have their interactions with their child's provider audio-recorded. In addition to that, participants completed a 1 ˝ hour semi-structured interview designed to examine both asthma management and explanatory models of asthma endorsed by parents. The interviews focused on the family's social and economic context, their experience of living with a child with asthma, explanatory models of asthma, asthma management routines, medication use, as well as experiences interacting with their providers. Findings from the interviews revealed four primary ways in which parents described their approach to medications with respect to the way in which they had been prescribed: 1) congruent approach, 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. Most Latino parents' approach medication use resembled a congruent approach, however, others fell under the rubric of the other three approaches listed above. Based on the analysis of parent-provider audio-recorded interactions, this study describes how differences in communication patterns during the parent-provider encounter seem to influence the approaches adopted by the parents.

Learning Objectives: