A Systematic Review of Patient- and Family-Level Inhaled Corticosteroid Adherence Interventions in Black/African Americans

Riley, Isaretta; Murphy, Beverly; Razouki, Zayd A; Krishnan, Jerry A.; Apter, Andrea J.; Okelo, Sande O.; Kraft, Monica; Feltner, Cindy; Que, Loretta G.; Boulware, L. Ebony

doi:10.1016/j.jaip.2018.10.036

Cited by 15 publications

(12 citation statements)

References 42 publications

(98 reference statements)

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“…The ethos behind SDM is that the patient's goals and preferences are important factors in clinical decisions that ultimately affect the patient [9]. Yet, SDM interventions are often developed without patient input [13]. In this study we sought to understand ways to improve ICS adherence and what components of an asthma adherence intervention, if any, were important to patients, family members, and friends to inform the development of an intervention that is transferrable to clinical care and low-resource settings.…”

Section: Discussionmentioning

confidence: 99%

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African Americans Want a Focus on Shared Decision-Making in Asthma Adherence Interventions

George

Arcia

Chung

et al. 2019

Patient

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BACKGROUND-Inhaled corticosteroids (ICS) reduce asthma-related morbidity and mortality. However, ICS non-adherence is more common in African American (AA) adults than White adults and explains, in part, the marked asthma disparities that AAs experience. We aimed to understand how ICS non-adherence could be addressed from the perspective of AA adults with asthma, their family, and friends.METHODS-We held six focus groups at two urban federally-qualified health centers separately with adult asthma patients (n = 2), with patients' family/friends (n = 2), and with patients and family/friends together (n = 2). Qualitative descriptive methodology guided the design and the conduct of focus groups. Verbatim transcripts were analyzed by three coders working independently using conventional content analysis to capture responses to interview questions and to identify emergent categories.RESULTS-Forty-six AA adults participated (32 patients, 14 family/friends); 67% were female. Participants stated that ICS adherence could be improved if they were heard, respected, and received patient-centered care; and if providers highlighted the risk of ICS non-adherence at clinic visits. Though not explicitly described by participants as shared decision-making (SDM), what they described included many essential elements of SDM.CONCLUSIONS-Participants desired SDM and offered reasons for ICS non-adherence that could be used to inform an SDM intervention for clinical application. Strategies informed by the

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Section: Discussionmentioning

confidence: 99%

“…As such, these interventions are ill-suited for translation and integration more broadly into clinical care. More broadly, few interventions focus on AA adults or on improving ICS adherence [13] and rarely are interventions informed by patient or family input [14].…”

Section: Introductionmentioning

confidence: 99%

African Americans Want a Focus on Shared Decision-Making in Asthma Adherence Interventions

George

Arcia

Chung

et al. 2019

Patient

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“…6 If ICS adherence was higher among Black adults, 25% of asthma exacerbations leading to hospital care could be averted. 7,8…”

Section: Introductionmentioning

confidence: 99%

“…6 If ICS adherence was higher among Black adults, 25% of asthma exacerbations leading to hospital care could be averted. 7,8 Barriers to ICS adherence in Black populations have been well-documented in the literature and reflect access issues, a preference for non-prescription treatments, suboptimal communication between patients and providers, and erroneous or negative medication beliefs. 2,[9][10][11] A recent systematic review identified the absence of tailored interventions for increasing ICS use specifically for Black populations.…”

Section: Introductionmentioning

confidence: 99%

“…2,[9][10][11] A recent systematic review identified the absence of tailored interventions for increasing ICS use specifically for Black populations. 8,12 What is not well understood is how selfmanagement decisions are identified and addressed during clinical encounters. Determining if and how providers discuss obstacles to ICS adherence with their adult patients could be useful to identify targets for tailored interventions.…”

Section: Introductionmentioning

confidence: 99%

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Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma

Norful

Bilazarian

Chung

et al. 2020

J Prim Care Community Health

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Background: Inhaled corticosteroids (ICS) are the foundation of asthma management. However, ICS non-adherence is common. Black adults have lower ICS adherence than white adults, which likely contributes, in part, to the asthma disparities that Black adults experience. Objective: To explore how Black adults with uncontrolled asthma and their primary care providers communicated about ICS non-adherence and used shared decision-making to identify strategies to increase ICS use. Design: Eighty routine clinical visits for uncontrolled asthma were audio recorded and inductively analyzed using methods adapted from grounded theory methodology. Participants: Study participants included 80 Black adults (83% female) largely low-income (83% Medicaid) and their 10 primary care providers. The study settings were 2 Federally Qualified Health Centers. Key Results: Three overarching themes were identified: (1) ICS misuse and lack of knowledge; (2) external influences informed personal misconceptions about ICS; and (3) patient-provider communication to individualize plan of care. Conclusions: Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence. Future research should include PCP training on strategies that support patient-centered care, such as communication, shared decision-making and patient engagement.

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Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals

et al. 2021

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IMPORTANCEAs stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD.OBJECTIVE To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals.DATA SOURCES This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases.STUDY SELECTION Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation. DATA EXTRACTION AND SYNTHESISThe PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R. MAIN OUTCOMES AND MEASURESPrevalence and risk factors associated with ADHD among Black individuals were identified.RESULTS A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study. CONCLUSIONS AND RELEVANCEContrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.

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A Systematic Review of Patient- and Family-Level Inhaled Corticosteroid Adherence Interventions in Black/African Americans

Cited by 15 publications

References 42 publications

African Americans Want a Focus on Shared Decision-Making in Asthma Adherence Interventions

African Americans Want a Focus on Shared Decision-Making in Asthma Adherence Interventions

Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma

Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals

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