Inhaled corticosteroid beliefs, complementary and alternative medicine, and uncontrolled asthma in urban minority adults.
Inhaled corticosteroid beliefs, complementary and alternative medicine, and uncontrolled asthma in urban minority adults.
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DOI：
10.1016/j.jaci.2014.07.044
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发表时间：
2014-12
影响因子：
14.2
通讯作者：
Shea, Judy A.
中科院分区：
文献类型：
--
作者：
George, Maureen;Topaz, Maxim;Rand, Cynthia;Sommers, Marilyn (Lynn) Sawyer;Glanz, Karen;Pantalon, Michael V.;Mao, Jun J.;Shea, Judy A.
关键词：
许多因素导致哮喘失控；对吸入性糖皮质激素（ICS）的负面观念以及对补充和替代医学（CAM）的认可，这两种情况在黑人成年人中比在白人成年人中更为普遍。
这项混合方法研究：1）开发了一种识字要求低的简易自评工具，并对其进行了心理测量测试，以识别对ICS的负面观念以及对CAM的认可；2）评估了该工具作为初级保健中沟通提示的临床效用。
全面的文献综述和内容专家确定了我们工具的候选项目，该工具分发给304人进行心理测量测试。在第二阶段，对33次有录音的初级保健就诊进行内容分析，对该工具的临床效用进行了初步评估。
对该工具的心理测量测试确定了17个项目，分别代表对ICS的观念（α = 0.59）和对CAM的认可（α = 0.68）。重测分析显示出高度的可靠性（CAM项目的组内相关系数为0.77，ICS项目为0.79）。我们发现对CAM的认可率（93%）、对ICS的负面观念（68%）以及哮喘失控（69%）的比例都很高。对CAM的认可与哮喘失控显著相关（p = 0.04）。定性数据分析为该工具的临床效用提供了初步证据，即了解对ICS的观念和对CAM的认可促使医疗服务提供者与患者展开讨论。
对ICS的负面观念和对CAM的认可很常见，并且与哮喘失控有关。一种简易的自评工具，能够识别可能影响ICS依从性的观念和行为，可能是一种改变诊所就诊期间沟通内容的有力工具。
Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are two that are more prevalent in Black as compared to White adults. This mixed methods study 1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and; 2) evaluated the clinical utility of the tool as a communication prompt in primary care. Comprehensive literature reviews and content experts identified candidate items for our instrument that was distributed to 304 individuals for psychometric testing. In the second phase, content analysis of 33 audio recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. Psychometric testing of the instrument identified 17 items representing ICS beliefs (α .59) and CAM endorsement (α .68). Test-retest analysis demonstrated a high level of reliability (ICC .77 for CAM items and .79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (p=.04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. Negative ICS beliefs and CAM endorsement were common and were associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence may be a leveraging tool to change the content of communication during clinic visits.
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