INTERVENTION STRATEGIES TO IMPROVE MATERNAL ADHERENCE

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A series of studies which will permit the assessment of intervention strategies designed to enhance maternal adherence to medical recommendations for children's health problems is proposed. The intervention strategies will be directed at mothers, at pediatricians, and at other members of the pediatric health care team. Each of the studies will be conducted by employing an experimental design (i.e., with experimental and control groups) and compliance will be determined by a combination of objective and subjective measures. Whenever possible interventions would be tested under conditions involving both acute and chronic conditions and involving mothers of varying socioeconomic status. The strategies would include such techniques as: teaching the provider to perform a compliance-oriented "educational diagnosis"; increasing contact between provider and mother through telephone follow-up; providing information in varying formats (including tests of Patient Package Inserts); and modifying structural characteristics of the regimen. An example of one of the proposed studies, a pediatrician-directed education intervention, is presented in detail. Primary care pediatricians and pediatric housestaff would be randomly assigned to either of two levels of pediatrician-directed education (Tutorial and Written Material or Written Material-Alone) or a control group. A post-intervention interview and questionnaire will provide assessments of compliance-oriented knowledge, attitudes and behaviors of pediatricians. For each pediatrician, a sample of children having otitis media or asthma will be randomly selected. A post-intervention interview will provide assessments of mothers' compliance-oriented health beliefs and satisfaction with the pediatrician-maternal interaction. Compliance outcomes and child health outcomes will be measured.