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Pediatric asthma: a look at adherence from the patient and family perspective
Christina D Adams1, Meredith L Dreyer, Chitra Dinakar
1Developmental and Behavioral Sciences, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. cadams@cmh.edu
Insights
Pediatric asthma adherence remains a challenge, with children intentionally experimenting with treatments. Understanding these patient decisions is key to improving adherence and health outcomes.
Area of Science:
- Pediatric Pulmonology
- Behavioral Science in Medicine
- Health Services Research
Background:
- Despite extensive research, pediatric asthma nonadherence remains prevalent.
- Current approaches often lack a truly patient-centered focus, overlooking patient decision-making.
- Families are increasingly involved in treatment but may not fully grasp patient adherence challenges.
Purpose of the Study:
- To highlight the need for a paradigm shift in pediatric asthma adherence research.
- To emphasize the importance of understanding patients' volitional nonadherence and decision-making processes.
- To explore how understanding patient 'experiments' can guide healthcare providers.
Main Methods:
- Qualitative analysis of patient and family interactions with treatment regimens.
- Review of existing literature on adherence barriers and facilitators.
- Conceptual framework development for patient-centered adherence decision-making.
Main Results:
- Pediatric asthma patients engage in both inadvertent and volitional nonadherence.
- Nonadherence often stems from patients 'experimenting' to balance disease and treatment burdens.
- Current adherence strategies do not adequately address these purposeful patient decisions.
Conclusions:
- A patient-centered approach is crucial for advancing pediatric asthma adherence.
- Understanding the rationale behind patients' adherence 'experiments' can inform better clinical guidance.
- Guiding adherence decisions can lead to improved quality of life and clinical outcomes for pediatric asthma patients.
Abstract:
Although extensive research has been done in an effort to understand and promote adherence in pediatric asthma, little progress has been made in reducing the prevalence of nonadherence. Some researchers argue that a paradigm shift is necessary to advance the adherence field. Despite the recent trend for increasing the role of families in determining treatment plans, a patient-centered approach has been lacking in adherence to a daily regimen. It is clear that, although patients and families show evidence of inadvertent nonadherence (eg, forgetfulness), they also engage in volitional or intentional nonadherence, via reasoned and purposeful decisions. Patients conduct "experiments" with their regimen components in an effort to balance the burden of disease with the burden of treatment. These experiments typically involve some degree of nonadherence. Perhaps, if researchers strive to better understand the decision-making process involved in these experiments, health care providers can guide families in making adherence decisions that would lead to attainment of treatment goals, improvement in quality of life, and realization of positive clinical outcomes.
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