Maternal health beliefs and practices, psychosocial factors, and medication use in children with asthma

Background: Caregivers of children with asthma often have health beliefs that can influence treatment adherence. Understanding these health beliefs, psychosocial factors, and their relationship to treatment may improve outcomes. The purpose of the study is to examine the association of maternal health beliefs and practices, psychosocial factors, and medication adherence using the ratio of controller medications to total asthma medication, a proxy of medication adherence in asthma. Previous studies have documented that a ratio of 0.5 or greater is associated with fewer adverse events.

Methods: These data come from a randomized controlled trial that tested a communication intervention in inner-city families of children ages 5-12 with poorly controlled asthma. 157 mothers of primarily African American children were interviewed using standardized measures about health beliefs and practices, psychosocial factors (CESD- depressive symptoms, employment status, neighborhood characteristics), asthma symptoms, and medication use at baseline and at 12 month follow-up. Appropriate controller and short acting beta agonist (SABA) medication use was based on pharmacy dispensation records of all asthma medications dispensed over the 12 month follow-up for each child. Descriptive statistics were used to summarize categorical variables and chi square was used to examine relationships.

Results: Only 58% of children obtained controller to total asthma medication ratios equal to or above 0.5. Mothers' depressive symptoms (p=.07) was the only psychosocial variable approaching significance relating to a lower ratio. Specific caregiver health beliefs and practices were positively related to a lower ratio (difficulty in helping child take medicines as prescribed, p= 0.04; hard to take meds when child feels fine, p=0.03; getting child to take meds out in public, p=0.03; and not giving controller meds every day p=0.004).

Conclusion: Health beliefs and practices relating to difficulties in following medication regimens were associated with lower controller to total asthma medication ratios or medication adherence. Further research should be done to assess how public health nurses can promote greater adherence by addressing maternal perceptions of difficulty in following recommendations and to further explore the relationship of maternal depression to these perceptions.