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APHA Scientific Session and Event Listing

Ellen S. Cohn, ScD¹, Barbara G. Bokhour, PhD², Dharma Cortes, PhD³, and Leanne S. Yinusa-Nyahkoon, MS¹. (1) Dept. of Occupational Therapy and Rehabilitation Counseling, Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, 617-358-1063, ecohn@bu.edu, (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) Department of Psychiatry, Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139

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. However, fewer than half of all children with persistent asthma use these controller medications as prescribed and controller use is less likely among African- American and Latino children. Although the underlying causes of these disparities are not well understood, research has suggested that parenting beliefs are one of many important factors in decision making about medical recommendations. Understanding parents' unfolding process of learning to manage their children's asthma may enhance practitioners' efforts to custom design interventions for parents at different points in their process of coming to understand their children's asthma.

This study examined parents' trajectory of coming to understand the benefits of controller asthma medication for their children with persistent asthma as reported by 44 parents of children, age 5 to 12 with a diagnosis of persistent asthma. The sample included African American, Latino and Caucasian parents who participated in 1 ½ hour semi-structured interviews. The interviews focused on understanding the family's experience of living with a child with asthma, the social and economic context, explanatory models of asthma, interactions with their providers, asthma management routines and medication use. Parents were interviewed by an investigator who was the same race/ethnicity as the participant, and Latino participants were interviewed in Spanish when requested. Five investigators conducted detailed qualitative analysis using narrative and sociolinguistic analysis and thematic analysis with a grounded theory structure. Findings revealed that parents who made the shift from being worried about inhaled anti-inflammatory medication to recognizing benefits all experienced a “turning point” or a change in their belief system. The shift in beliefs enabled parents to appreciate the benefit of preventive medication. Three different pathways led to these turning points: proactive education, a crisis related to asthma, and/or longevity or experience living with a child with asthma. The majority of parents without turning points were either African-American or Latino. The differences and commonalities in the factors that facilitated or interfered with these turning points will be described. To reduce disparities in asthma intervention, recommendations for patient-provider communication and interventions to facilitate positive turning points will be suggested.

Learning Objectives: