Investigating the Role of Parental Social Support, Patient-Provider Relationships, and Illness-Related Beliefs on Childhood Asthma Outcomes

Abstract

Introduction: This study broadly aimed to expand our understanding of asthma disparities among PR and Mexican children by assessing the relationship between psychosocial factors and asthma outcomes. More specifically, the study assessed the impact of caregivers' social support from family and friends and caregivers' perceived relationships with healthcare providers on asthma control and controller medication adherence. Additionally, using the Common Sense Model (CSM) of Illness Representation as a theoretical framework, the impact of health-related beliefs and ethnic differences in such beliefs were investigated.;Methods: Parent-child dyads (N=267) of Mexican and Puerto Rican (PR) descent participated in the study. Subjects were recruited from asthma clinics at two inner-city hospitals in Bronx, NY, two school-based health clinics in Phoenix, AZ, and a mobile asthma clinic in Phoenix, AZ. All children had a diagnosis of asthma. Measures included: Social Networks Questionnaire, Asthma Illness Representation Scale, and Asthma Control Test and Childhood Asthma Control Test. Adherence was calculated using electronic doser devices and TrackCaps attached to children's medications. Patients' use of controller medications was also assessed by comparing self-reported use to prescription records obtained through medical chart review.;Results: Objectively measured adherence to controller medications was low in our sample (inhaled corticosteroids (ICS): M= 42.75% +/- 32.03%, leukotriene receptor antagonists (LTRA): M= 54.25% +/- 30.72%). Adherence was significantly associated with well-controlled asthma (p = .01). Patient-healthcare provider relationships also were significantly and positively related to asthma control, even after controlling for the effects of the child's gender and ethnicity (p = .005). However, adherence did not vary by ethnic group, although PR participants were significantly more likely than Mexicans to lose their dosers and/or medications. Participants' adherence to controller medications was not significantly related to social support (total support: p = .75, family support: p = .96, friend support: p = .59), caregivers' relationships with providers (p = .94), or illness representations (Nature of Symptoms: 9 = -.08,p = .46, Facts About Asthma: 9 = .19,p = .08, Attitudes Towards Anti-Inflammatory Medication: 9 = .14, p = .19, Treatment Expectations: 9 = .21,p = .06, Emotional Aspects of Medication: 9 = -.06,p = .59).;Overall illness representations were found to be midway between the professional and lay models of health beliefs (AIRS Total Score: M = 3.08 +/- .35). Mexican caregivers were significantly more likely to have treatment expectations aligned with the professional model (M= 3.07 +/- .59) than PR caregivers (M= 2.76 +/- .451), p = .001. There were no between-group differences on overall illness representations or any of the other subscales. Illness representations were also positively and significantly related to caregivers' relationships with providers (AIRS Total Score: p < .001, Nature of Symptoms: r = .28,p < .001, Facts About Asthma: r = .44,p < .001, Attitudes Towards Anti-Inflammatory Medication: r = .37, p < .001, Treatment Expectations: r = .16,p <. 05, Emotional Aspects of Medication: r = .37,p < .001). Finally, illness representations were significantly related to asthma control, with children whose caregivers held professional illness beliefs being more likely to have well-controlled asthma (p < .001). There was no interaction effect between illness representation and ethnicity on asthma control.;Conclusions: Implications of these results suggest that, in the sample studied, psychosocial factors (i.e., social support, relationships with providers, health-related beliefs) affect overall asthma control but not adherence to asthma controller medications. This highlights the complexity of asthma management and control and draws attention to the low rates of medication adherence observed in minority samples. Further, the between-group differences, such as differences in illness representations and the greater loss of ICS medications among PR, reinforces the importance of uniquely considering the needs of each ethnic group when treating pediatric asthma.