Abstract
Purpose
Adolescents with asthma often report poor medication adherence and asthma control. Cognitive factors embedded in the social cognitive theory including self-efficacy, outcome expectations, and barrier perceptions may explain poor asthma outcomes in this population. This study was performed to examine the extent to which these cognitive factors are intercorrelated and explain medication adherence and asthma control in urban adolescents.
Patients and methods
A total of 373 urban adolescents (12–20 years) with asthma completed questionnaires measuring asthma-related self-efficacy, outcome expectations, barrier perceptions, medication adherence, and asthma control. Multiple linear regression was conducted to examine the extent to which the three cognitive factors predicted medication adherence and asthma control after controlling for covariates including age, sex, household income, and age at diagnosis.
Results
Participants’ ages were on average 14.68 (±1.94) years; 50% were female, and most (78.6%) were African American. Higher self-efficacy associated with lower barrier perceptions and higher outcome expectations (r=0.50, p<0.001; r=−0.26, p<0.001, respectively). Self-efficacy predicted better asthma control (B=−0.098, p=0.004) and adherence (B=0.426, p=0.011), whereas barrier perceptions predicted poorer asthma control (B=0.13, p<0.001) and adherence (B=−0.568, p<0.001). Self-efficacy independently predicted fewer missed doses (B=−0.621, p=0.006), and barrier perception independently predicted asthma control (B=0.12, p<0.001) and adherence (B=−0.519, p<0.001).
Conclusion
Improving medication adherence and asthma control among adolescents may require a multifaceted approach. Interventions focused on increasing self-efficacy and addressing barriers, actual or potential, to medication adherence could ameliorate asthma disparities in urban adolescents.
Acknowledgments
The authors thank Dr Annette Grape for her expertise and time in preparing the data set for analysis, and Mr Curtis Roby for his thoughtful editorial assistance. They would also like to express their gratitude to adolescent participants who willingly shared their data with the study team. This work was supported by the National Institute of Health/National Institute for Nursing Research (grant number: R01NR014451). Part of the data reported in this manuscript has been presented as a poster titled “Cognitive concepts predicting medication adherence and asthma control in inner city adolescents” in Sigma Theta Tau International 28th International Nursing Research Congress held in Dublin in July 2017.
Disclosure
The authors report no conflicts of interest in this work.