The Impact of Household Composition, Asthma-Related Health Beliefs and Parental Perceived Stress on Medication Adherence and Functional Morbidity in Pediatric Asthma

Abstract

Objective. This study sought to explore potential reasons for the low rates of adherence to controller medications and high functional morbidity in children with asthma in an inner-city sample. The impact of household composition, attitudes regarding prescribed medication, and perceived stress on functional morbidity and rates of adherence was examined. Research has shown that each of these psychosocial variables has directly impacted functional morbidity and rates of adherence. This study sought to examine the combined effects of these variables on asthma functional morbidity and treatment adherence.;Methods. Participants were 250 parent-child dyads recruited from inner-city clinics in the Bronx, NY. Child age ranged from 7 to 15 years old with a mean of 10.08 (+/- 2.08) years. Illness representations were measured using the Asthma Illness Representation Scale (AIRS). Household Composition was separated into groups; households comprised of one adult and households comprised of two or more adults. Perceived Stress was measured using the Perceived Stress Scale (PSS-4). Functional Morbidity was measured using the Asthma Functional Severity Scale (AFSS). Adherence was calculated from electronic data obtained using doser devices over a 6-week span. Ethnicity, which included those who identified as Caucasian, Puerto Rican, African American, Mexican, or Afro-Caribbean, was defined as the identified ethnicity of the primary caregiver.;Results: There were no statistically significant differences found in asthma morbidity (both 4 weeks and twelve months prier to the study) by household composition. Additionally in this sample no statistically significant differences were found in adherence to Inhaled Corticosteroids (ICS) by household composition. 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)). There were no statistically significant differences in single vs. multiple parent families relative to asthma illness representations. However, consistent with the literature, alignment with the lay model of asthma was associated with increased asthma functional morbidity. Families with at least two adults did not report less stress than families with a single adult. No significant relationships were found between perceived stress and asthma functional morbidity or adherence. Secondary analyses looking at aspects of healthcare utilization as additional measures of functional morbidity found that caregivers in households headed by a single adult reported a greater number of sick visits for their children with asthma (M = 1.30, SD = .76) [F (1,129) = 4.80, p = .03] than their counterparts in households headed by two or more adults (M = 1.00, SD = .83).;Conclusions. Findings were inconsistent with the literature on the relationship between household composition and its impact on medication adherence and asthma functional morbidity. Nor was a relationship found between household composition and asthma illness representations. However, caregivers in households headed by a single adult reported a greater number of sick visits for their children with asthma. Future research and novel methodologies are needed to characterize the relationship and pathways associated with caregiver stress and household composition at multiple levels to more fully understand and address asthma morbidity and treatment adherence and to design potential interventions.