Rhee Hyekyun, Wicks Mona N, Dolgoff Jennifer S, Love Tanzy M, Harrington Donald
University of Rochester School of Nursing, Rochester, NY, USA.
College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA.
Patient Prefer Adherence. 2018 May 24;12:929-937. doi: 10.2147/PPA.S162925. eCollection 2018.
Adolescents with asthma often report poor medication adherence and asthma control. Cognitive factors embedded in the social cognitive theory including self-efficacy, outcome expectations, and barrier perceptions may explain poor asthma outcomes in this population. This study was performed to examine the extent to which these cognitive factors are intercorrelated and explain medication adherence and asthma control in urban adolescents.
A total of 373 urban adolescents (12-20 years) with asthma completed questionnaires measuring asthma-related self-efficacy, outcome expectations, barrier perceptions, medication adherence, and asthma control. Multiple linear regression was conducted to examine the extent to which the three cognitive factors predicted medication adherence and asthma control after controlling for covariates including age, sex, household income, and age at diagnosis.
Participants' ages were on average 14.68 (±1.94) years; 50% were female, and most (78.6%) were African American. Higher self-efficacy associated with lower barrier perceptions and higher outcome expectations (=0.50, <0.001; =-0.26, <0.001, respectively). Self-efficacy predicted better asthma control (=-0.098, =0.004) and adherence (=0.426, =0.011), whereas barrier perceptions predicted poorer asthma control (=0.13, <0.001) and adherence (=-0.568, <0.001). Self-efficacy independently predicted fewer missed doses (=-0.621, =0.006), and barrier perception independently predicted asthma control (=0.12, <0.001) and adherence (=-0.519, <0.001).
Improving medication adherence and asthma control among adolescents may require a multifaceted approach. Interventions focused on increasing self-efficacy and addressing barriers, actual or potential, to medication adherence could ameliorate asthma disparities in urban adolescents.
患有哮喘的青少年常常报告药物依从性差且哮喘控制不佳。社会认知理论中包含的认知因素，包括自我效能感、结果期望和障碍认知，可能解释了该人群哮喘预后不佳的原因。本研究旨在探讨这些认知因素之间的相互关联程度，并解释城市青少年的药物依从性和哮喘控制情况。
共有373名年龄在12至20岁之间的城市哮喘青少年完成了问卷调查，这些问卷用于测量与哮喘相关的自我效能感、结果期望、障碍认知、药物依从性和哮喘控制情况。在控制了年龄、性别、家庭收入和诊断年龄等协变量后，进行多元线性回归分析，以检验这三个认知因素对药物依从性和哮喘控制的预测程度。
参与者的平均年龄为14.68（±1.94）岁；50%为女性，大多数（78.6%）为非裔美国人。较高的自我效能感与较低的障碍认知和较高的结果期望相关（分别为r = 0.50，P < 0.001；r = -0.26，P < 0.001）。自我效能感预测了更好的哮喘控制（β = -0.098，P = 0.004）和依从性（β = 0.426，P = 0.011），而障碍认知预测了较差的哮喘控制（β = 0.13，P < 0.001）和依从性（β = -0.568，P < 0.001）。自我效能感独立预测了更少的漏服剂量（β = -0.621，P = 0.006），而障碍认知独立预测了哮喘控制（β = 0.12，P < 0.001）和依从性（β = -0.519，P < 0.001）。
改善青少年的药物依从性和哮喘控制可能需要多方面的方法。专注于提高自我效能感以及解决实际或潜在的药物依从性障碍的干预措施，可能会改善城市青少年的哮喘差异。
