Department of Psychology, Auburn University, Auburn University, AL.
Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.
Pediatr Pulmonol. 2018 May;53(5):668-684. doi: 10.1002/ppul.23966. Epub 2018 Feb 20.
To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains.
Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality.
Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies.
All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
系统回顾个体、家庭、社区和医疗保健系统领域中与儿童哮喘吸入皮质激素（ICS）依从性相关的因素。
使用 PsychINFO、Medline 和 CINAHL 检索了 1997 年至 2016 年发表的评估儿童哮喘药物依从性的文章。检索词包括哮喘、依从性、自我管理、依从性、儿童和青少年。搜索结果仅限于以下文章：1）在美国发表的文章；2）使用儿科人群（0-25 岁）；3）呈现与 ICS 依从性相关的原始数据。根据儿科自我管理模型的领域对依从性的相关因素进行分类。对每篇文章的研究质量进行评估。
共有 79 篇文章纳入综述。家庭层面的相关性最常被报道（N=51），包括社会经济地位、种族/民族、健康行为和哮喘知识。个体层面的相关性次之（N=37），年龄是最常被确定的与依从性呈负相关的因素。医疗保健系统相关性（N=24）包括增强的哮喘护理和患者-提供者沟通。很少有研究（N=10）研究了与依从性相关的社区相关性。整体研究质量中等，只有少数定量文章（26.38%）和定性文章（21.4%）参考了其研究的理论基础。
所有儿科自我管理模型领域都与青少年的依从性相关，这表明药物依从性受到多个系统的影响；然而，大多数研究仅在单个领域评估了依从性的相关性。需要进行跨越多个领域的未来研究，以深入了解依从性的决定因素。
