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Cognitive factors predict medication adherence and asthma control in urban adolescents with asthma

Authors Rhee H, Wicks MN, Dolgoff JS, Love TM, Harrington D

Received 18 January 2018

Accepted for publication 31 March 2018

Published 24 May 2018 Volume 2018:12 Pages 929—937

DOI https://doi.org/10.2147/PPA.S162925

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen


Hyekyun Rhee,1 Mona N Wicks,2 Jennifer S Dolgoff,2 Tanzy M Love,3 Donald Harrington3

1University of Rochester School of Nursing, Rochester, NY, USA; 2College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA; 3Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA

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.

Keywords: self-efficacy, outcome expectation, barrier perception, social cognitive theory

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