Accuracy of children's self-reported adherence to treatment

To examine the relationship between self-reported and electronically monitored adherence to a recommended asthma treatment and to assess the accuracy of the diary data reported by school-age children.

A randomized, controlled clinical trial of the effectiveness of an asthma self-management program. The relationship between self-reported and electronically recorded daily peak expiratory flow rate (PEFR) adherence was assessed in a sample of 42 children, ages 7 through 11 years with moderate to severe asthma in one community in West Virginia, USA. Cognitive social learning theory served as the framework for the intervention.

At-home adherence to PEFR monitoring during the 5-week study was evaluated using the self-report Asthma Diary and an electronic PEFR meter. Recommended twice daily (morning and evening) PEFR monitoring was measured.

Self-reported and electronically recorded PEFR adherence were modestly correlated. Self-reported adherence was significantly higher than electronically monitored adherence during Week 5. Accuracy of the self-reported PEFR declined over time, and over half of the children fabricated at least one PEFR value during the final week of the study.

Clinicians often evaluate the efficacy of prescribed treatment for children with chronic conditions based on the children's self-reported diary data. The findings indicate that these children's self-reported adherence behaviors contained errors. Parent education regarding supervision of children's adherence, including validating the accuracy of diary data, is critical for successful self-management in children with chronic conditions.