“这有点像是一种责任的事情”：青少年和年轻成年人在哮喘药物治疗依从性方面的过渡挑战。
"It is kind of like a responsibility thing": transitional challenges in asthma medication adherence among adolescents and young adults.
机构信息
Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
出版信息
J Asthma. 2022 May;59(5):956-966. doi: 10.1080/02770903.2021.1897836. Epub 2021 Mar 23.
OBJECTIVE
Nonadherence to asthma medications is prevalent among adolescents and young adults (AYAs) with asthma, leading to worsened control of asthma symptoms and more frequent exacerbations. AYAs have unique developmental transitional challenges that may alter medication adherence. We aimed to use a socio-ecological framework to explore the effect of transitional challenges from adolescence to young adulthood on asthma controller medication adherence and to identify possible strategies to promote medication adherence.
METHODS
We conducted qualitative semi-structured interviews by phone with 7 adolescents (14 to 17 years), their respective caregivers, and 7 young adults (18 to 30 years). Participants were recruited from a respiratory clinical trial network and pulmonary clinics in 4 states at 6 different sites through convenience sampling. Interviews were audio recorded, transcribed and coded using thematic analyses.
RESULTS
Participants identified personal challenges affecting adherence to asthma medications during the transition from adolescence to young adulthood including responsibility for asthma self-management, understanding of asthma condition and severity, embarrassment, and life demands. Health systems factors including medication cost, challenges with insurance, difficulties obtaining refills, and difficulty with access to medications at school also impacted asthma medication adherence. Participants recommended adherence strategies including improved access to inhalers, incorporating asthma medications into daily routines, and using reminders.
CONCLUSIONS
Focusing on the transitional challenges of AYAs during the time period from adolescence to young adulthood is necessary for supporting their asthma medication adherence and creating future interventions. Socio-ecological and systems factors should also be targeted for improved asthma medication adherence.
UNLABELLED
Supplemental data for this article can be accessed online at https://doi.org/10.1080/02770903.2021.1897836.
目的
哮喘青少年和年轻人（AYA）普遍存在不遵医嘱用药的情况，导致哮喘症状控制恶化，发作更频繁。AYA 具有独特的发展过渡挑战，可能改变药物的依从性。我们旨在使用社会生态框架探讨从青少年到成年早期的过渡挑战对哮喘控制药物依从性的影响，并确定促进药物依从性的可能策略。
方法
我们通过电话对 7 名青少年（14 至 17 岁）、他们各自的照顾者以及 7 名年轻人（18 至 30 岁）进行了半结构化的定性访谈。参与者是通过便利抽样从 4 个州的 6 个不同地点的呼吸临床试验网络和肺诊所招募的。使用主题分析对访谈进行录音、转录和编码。
结果
参与者确定了在从青少年到成年早期的过渡期间影响哮喘药物依从性的个人挑战，包括对哮喘自我管理的责任、对哮喘状况和严重程度的理解、尴尬和生活需求。健康系统因素，包括药物成本、保险挑战、难以获得续药以及在学校获得药物的困难，也影响了哮喘药物的依从性。参与者建议采用依从性策略，包括改善吸入器的可及性、将哮喘药物纳入日常常规以及使用提醒。
结论
在从青少年到成年早期的过渡期间，关注 AYA 的过渡挑战对于支持他们的哮喘药物依从性和创建未来干预措施是必要的。社会生态和系统因素也应作为提高哮喘药物依从性的目标。
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本文的补充数据可以在 https://doi.org/10.1080/02770903.2021.1897836 在线获取。
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