The Impact of Complementary and Alternative Medicine Use, Attitudes towards Prescribed Regimens, and Maternal Depression on Adherence to Asthma Controller Medication

Abstract

Objective. This study sought to explore potential reasons for the low rates of adherence to controller medications in children with asthma in an inner-city sample. The impact of complementary and alternative medicine (CAM), attitudes regarding prescribed medication, and maternal depression on rates of adherence were examined. Additionally, ethnic differences and acculturation were examined to determine the degree to which they explain low rates of adherence in this sample. The overall goal of this study was to increase understanding of relationships that contribute to low rates of adherence to asthma controller medication in children with asthma in order to inform interventions in the future.;Methods. Participants were 244 parent-child dyads recruited from inner-city clinics in the Bronx, NY. CAM use was measured using the CAM Checklist and illness representations were measured using the Asthma Illness Representation Scale (AIRS). Adherence was calculated from electronic data obtained using doser devices and TrackCaps over a 6-week span. Ethnicity, which included those who identified as Puerto Rican, African American, Mexican, or Afro-Caribbean, was defined as the identified ethnicity of the primary caregiver. Maternal depression was measured using the Structured Clinical Interview for DSM Disorders-I (SCID-I) research version.;Results. Adherence to inhaled corticosteroids (ICS) was approximately 37%, while adherence to leukotriene receptor agonists (LTRA) medication was 56%. While no differences in adherence to ICS were found between CAM users and nonusers, those who used Vicks Vaporub appeared to have significantly lower rates of adherence to LTRA (48.03%, SD = 30.84%) than those who did not use Vicks (62.51%, SD = 28.8%, F (1, 62) = 7.65, p = .007), within the subsample of those who were prescribed LTRA (n = 65). In this sample, no significant ethnic differences in type of CAM used or CAM rates were found overall, except for a trend towards increased rates of Manipulative/body-based practices in the Afro-Caribbean sample versus individuals of Puerto Rican or African American descent. When asked a single screening question regarding complementary and alternative medicine use, only 23.8% (n = 55) of the participants endorsed using CAM to treat their child's asthma versus 85.7% (n = 198) who endorsed use when a comprehensive checklist was administered. Overall, this sample of parents held overall asthma illness representations that were midway between the professional model of asthma and the lay model of asthma (AIRS score mean of 3.08 (SD = 0.38). AIRS score and LTRA adherence were positively correlated which showed a trend towards significance, but ICS showed no correlation to AIRS total or subscale scores. AIRS total score was lower in those who endorsed the use of Vitamins in the treatment of asthma versus those who did not. Maternal depression was not associated with AIRS score or adherence to controller medications.;Conclusions. This study reveals that in the sample studied, relationships between CAM, adherence, illness representations, and maternal depression may not be as strong as previously thought. Clinically, the study revealed that children tend to be more adherent to an oral versus an inhaled medication. Additionally, this study reinforces the necessity of specifically assessing for certain types of CAM used, not using a screening question. The finding related to Vicks Vaporub use and decreased adherence to LTRA emphasizes the need for asking about CAM use in clinical settings.