Inhaled corticosteroid beliefs, complementary and alternative medicine, and uncontrolled asthma in urban minority adults

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:134

Article

George, Maureen^1,2,4  Topaz, Maxim^1,5  Rand, Cynthia⁶  Sommers, Marilyn (Lynn) Sawyer^1,2,3  Glanz, Karen^1,4  Pantalon, Michael V.^8,9  Mao, Jun J.⁷  Shea, Judy A.⁷ 

[1] Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA

[2] Univ Penn, Sch Nursing, Dept Family & Community Hlth, Philadelphia, PA 19104 USA

[3] Univ Penn, Sch Nursing, Ctr Global Womens Hlth, Philadelphia, PA 19104 USA

[4] Univ Penn, Ctr Hlth Behav Res, Philadelphia, PA 19104 USA

[5] Univ Haifa, IL-31999 Haifa, Israel

[6] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[7] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[8] Yale Univ, Sch Med, Dept Psychiat, New Haven, CT USA

[9] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA

关键词: Asthma;    self-management;    instrument development;    beliefs;    complementary and alternative medicine;    inhaled corticosteroids;    adherence;    black;    minority;    urban;    mixed methods;    patient-provider communication;   

DOI  :  10.1016/j.jaci.2014.07.044

来源: Elsevier

【 摘 要 】

Background: Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults. Objectives: This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care. Methods: Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. Results: Psychometric testing of the instrument identified 17 items representing ICS beliefs (alpha = .59) and CAM endorsement (alpha = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. Conclusion: Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.

【 授权许可】

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