Lubbers, S.M. (2012) Barrières voor goede therapietrouw bij ouders van kinderen met astma. thesis, Medicine.
Full text available on request.Abstract
Background: Nonadherence to medication is a complex phenomenon, with a great variety of influencing factors. Improving adherence to inhaled corticosteroids (ICS) is important to reduce the burden of uncontrolled asthma in children. An ongoing study at the Princess Amalia Children’s Clinic which examines determinants of adherence in asthmatic children could not explain why some parents receiving comprehensive asthma care do not administer the prescribed medication to their child. In addition, qualitative studies aimed at achieving an in-depth understanding of barriers to ICS adherence in children with asthma are lacking. Objectives: The primary aim of this study is to identify reasons for nonadherence in parents of asthmatic children who receive comprehensive asthma care. Secondary aims are to determine how parents assess the intensive asthma care and how self-reported adherence relates to electronically measured adherence. Methods: Prospective qualitative study in parents of asthmatic children aged 2-12 years. ICS adherence in children of these parents was measured electronically for 1 year. We performed semistructured, in-depth interviews in parents with low and high adherence rates, exploring reasons for the high or low adherence. Opinions about the intensive asthma care by parents were also discussed. Self-reported adherence was measured by a validated questionnaire (MARS). Interviews were recorded, transcribed verbatim, and analysed using a grounded theory approach. Results: Parents of 20 children (median age 5.9 years, range 2.4 – 12.7 years) were interviewed. Two groups of parents with different patterns of nonadherence were identified. One group of mainly highly educated parents deliberately did not use the ICS according to doctor’s advice, but adjusted the ICS dose based on their perception of asthma control in their child (intentional nonadherence). This usually resulted in a regular use of ICS, but with a lower daily dose. The other group of parents, mostly with lower educational levels, experienced several barriers impeding regular ICS use. These barriers included a chaotic family life, multiple problems in families and children between 8 and 12 years who were given full responsibility for taking their ICS without parental supervision (erratic nonadherence). One third and a quarter of interviewed parents (mostly with low adherence), respectively, rated the scheduled visits to the asthma specialist physician and the asthma nurse as not valuable. Parents with low and high adherence did not show significantly different MARS scores. This was mainly caused by parents’ unawareness of not giving the medication to their child, or their unawareness that their child did not take the medication. Conclusion: Low use of ICS in asthmatic children, who receive comprehensive asthma care, is caused by intentional or erratic nonadherence of their parents, in which parental educational level seems to play a role. Intentional nonadherence does not appear to be a real problem, because most of these children do receive ICS on a regular basis. Erratic nonadherence by family-driven barriers appears to be more problematic. The excessive responsibility put on school-aged children to manage their own ICS medication taking is a striking finding, which needs attention.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleiders: and T. Klok drs. en and Brand, prof. dr. P.L.P. and Amalia kinderafdeling, Isala Klinieken te Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2010 |
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