Asthma medication adherence among urban teens: a qualitative analysis of barriers, facilitators and experiences with school-based care
Asthma medication adherence among urban teens: a qualitative analysis of barriers, facilitators and experiences with school-based care
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DOI：
10.3109/02770903.2014.885041
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发表时间：
2014-06-01
影响因子：
1.9
通讯作者：
Halterman, Jill S.
中科院分区：
文献类型：
--
作者：
Blaakman, Susan W.;Cohen, Alyssa;Halterman, Jill S.
目的：尽管有既定的临床指南，患有持续性哮喘的青少年并不总是接受日常预防药物或不按处方服用。本研究的目的是了解城市青少年在哮喘管理、预防性药物依从性和参与学校干预方面的经验。方法：患有持续性哮喘并接受预防性药物治疗的青少年（12-15 岁）参加了一项试点研究，其中包括每天在学校观察药物治疗和动机访谈。最终调查时进行了半结构化访谈。定性内容分析使数据编码能够识别主题。结果：主题分为“一般哮喘管理”或“特定计划”。对于一般管理，常规很重要，而匆忙会干扰服药。健忘最常见与不依从药物治疗有关。与学校准备和社会优先事项相关的相互竞争的需求是药物使用的障碍。独立用药与多种好处相关（例如避免父母的唠叨和感觉负责任/成熟）。具体项目的经历各不相同。一半的青少年表示与学校护士关系融洽，而少数人则认为护士不屑一顾。学校结构中意想不到的好处和障碍包括对离开教室的看法、到护士办公室的距离、大厅通行证的必要性和早间学校的惯例。重要的是，许多青少年将日常用药与哮喘症状减少联系起来，从而激励他们继续坚持用药。结论：患有哮喘的青少年受益于坚持预防性药物治疗，但在正确使用方面遇到许多障碍。提高依从性的干预措施必须适应学校的需求和独特的青少年优先事项。学校护士作为盟友的角色可能会支持青少年过渡到药物独立。
Objective: Teens with persistent asthma do not always receive daily preventive medications or do not take them as prescribed, despite established clinical guidelines. The purpose of this study was to understand urban teens' experiences with asthma management, preventive medication adherence and participation in a school-based intervention. Methods: Teens (12-15 years) with persistent asthma, and prescribed preventive medication, participated in a pilot study that included daily observed medication therapy at school and motivational interviewing. Semi-structured interviews occurred at final survey. Qualitative content analysis enabled data coding to identify themes. Results: Themes were classified as "general asthma management'' or "program-specific.'' For general management, routines were important, while hurrying interfered with taking medications. Forgetfulness was most commonly linked to medication nonadherence. Competing demands related to school preparedness and social priorities were barriers to medication use. Independence with medications was associated with several benefits (e. g. avoiding parental nagging and feeling responsible/mature). Program-specific experiences varied. Half of teens reported positive rapport with their school nurse, while a few felt that their nurse was dismissive. Unexpected benefits and barriers within the school structure included perceptions about leaving the classroom, the distance to the nurse's office, the necessity of hall passes and morning school routines. Importantly, many teens connected daily medication use with fewer asthma symptoms, incenting continued adherence. Conclusions: Teens with asthma benefit from adherence to preventive medications but encounter numerous barriers to proper use. Interventions to improve adherence must accommodate school demands and unique teen priorities. The school nurse's role as an ally may support teens' transition to medication independence.