Abstract and Introduction
This study examined the relationship between asthma illness representations and reported controller medication adherence of school-aged children (6–11 years) with persistent asthma and their parents. Thirty-four parent–child dyads independently reported on asthma controller medication adherence and asthma illness representations. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of reported medication adherence. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported adherence (β = .55, p < .01), and child treatment control was also a significant predictor of parent-reported adherence (β = −.50, p < .01). Child beliefs about medication necessity versus concerns was a significant predictor of child-reported adherence (β = .50, p < .01), and no parent variables reached significance. Although there are similarities between parent and child asthma illness representations, findings indicate that school-aged children develop illness representations somewhat independently from their parents and, therefore, are critical participants in both asthma care and research.
Asthma is one of the most common chronic diseases of childhood, affecting an estimated seven million children (0–17 years) in the United States (Bloom, Jones, & Freeman, 2013). Children ages 5 to 11 years are disproportionately represented, with an estimated 11% currently diagnosed with asthma (Bloom et al., 2013). Standard asthma medication management for children with persistent asthma includes daily controller medications to reduce and prevent airway inflammation (National Asthma Education Prevention Program (NAEPP), 2007). Despite strong evidence supporting the safety and efficacy of controller medications in the prevention of asthma morbidity, estimates place adherence to these medications below 50% (Herndon et al., 2012, Morton et al., 2014). Children who are nonadherent to controller medications experience lower quality of life and increased disease morbidity including asthma symptoms, exacerbations, sleep disruption, and school absences (National Asthma Education Prevention Program, 2007, Walders et al., 2005). Responsibility for pediatric asthma management, particularly medication adherence, is best conceptualized as parent–child shared management, reflecting the shared responsibility among parents/caregivers and the child (Kieckhefer & Trahms, 2000). Predictors of parent-reported asthma medication adherence include observable symptoms, perceived symptom severity, and medication efficacy beliefs (Ringlever et al., 2012, Yoos et al., 2007), but less is known about the effect of child beliefs about medications and asthma on asthma medication adherence and whether parent and child beliefs are similar.
Leventhal's Common Sense Model of Self-Regulation (Leventhal, Brissette, & Leventhal, 2003) may be a useful framework for understanding child asthma medication adherence (Sonney & Insel, 2016). Within the Common Sense Model of Self-Regulation, the illness representation construct provides the framework for self-management practices. Illness representations are composed of five interrelated domains: identity, or symptoms an individual associates with illness; timeline, or individual expectations related to the duration of the illness; consequences, or perceived severity of the illness; beliefs about causes of illness; and controllability, referring to the perceived efficacy of available treatments. Illness representations develop through an iterative process whereby individuals use common sense to appraise episodes or events that arise related to their illness.
Illness representation domains have been reported to be predictive of asthma controller medication adherence in both adults with asthma (Clifford et al., 2008, Federman et al., 2013, Halm et al., 2006, Sofianou et al., 2013) and parents of children with asthma (Klok et al., 2011, Peterson-Sweeney et al., 2003, Yoos et al., 2007). To our knowledge, however, there are no studies describing school-aged child asthma illness representations (Sonney, Gerald, & Insel, 2016). Among adolescents with asthma and their parents, dissimilar illness representations have been reported (Heyduck, Bengel, Farin-Glattacker, & Glattacker, 2015). Incongruence of parent and child illness representations is also evident in studies of children with Type 1 diabetes, another common chronic condition of childhood (Law, 2002, Olsen et al., 2008). Thus, understanding child asthma illness representations and their respective roles in parent–child shared management of asthma is an important gap in our current knowledge.
"Understanding child asthma illness representations and their respective roles in parent–child shared management of asthma is an important gap in our current knowledge."
The theoretical framework for this study was the Common Sense Model of Parent–Child Shared Regulation, a reformulation of Leventhal's Common Sense Model of Self-Regulation (Leventhal et al., 2003, Sonney and Insel, 2016). The Common Sense Model of Parent–Child Shared Regulation conceptualizes parent and child illness representations as separate constructs, which allows for individual differences. Parent and child illness representations together form a shared overall illness representation that reflects parent–child shared asthma management.
The purpose of this study was to (a) describe asthma illness representations of school-aged children with persistent asthma and their parents, (b) examine the interdependence between parent and child asthma illness representations, and (c) examine the relationship between controller medication adherence and asthma illness representations of both school-aged children and their parents.
J Pediatr Health Care. 2017;31(6):703-712. © 2017 Mosby, Inc.