Navajo Perceptions of Asthma and Asthma Medications: Clinical Implications

Abstract

ABSTRACT. Background. Despite the large number of asthma patients, relatively little is known about the beliefs of asthmatic children and their parent(s), or the extent to which these beliefs influence management of the disease.Objective. The purpose of this study was to examine how medication-taking and the use of health care services were influenced by perceptions of the disease and beliefs about medications among Navajo families.Methods. Ethnographic interviews were used to investigate the disease and medication beliefs of 22 Navajo families with 29 asthmatic children.Results. Most respondents perceived asthma as the transient experience of symptoms in someone who was chronically vulnerable to breathing problems. The majority (97%) of these asthmatics reported using bronchodilators, although only 34% reported current use of antiinflammatory medications. Although controller medications were distinguished from rescue medications, they were thought to have the same effect on the lungs. Many families were concerned about becoming dependent on the medicines and attempted to "wean" the asthmatic from the drugs. A large proportion (80%) of children had assumed responsibility for their own medication taking. Parents often referred to previous attacks requiring treatment in the emergency department when deciding whether to initiate medication or seek medical attention, often resulting in a delay of treatment. Nebulized treatments delivered in the emergency department were perceived to be the strongest therapy available. As a result, visits to the emergency department were common (79%), as were hospital admissions (57%).Conclusion. This study provides evidence that, among pediatric Navajo asthma patients, perceptions of asthma and beliefs about the activity of asthma medications influence when and how often asthma medicines are taken, as well as the use of health care services. In addition, excessive reliance on emergency treatments and the high rates of hospital admissions suggest that asthma is undertreated in this group of Navajo patients. Pediatrics 2001;108(1). URL: http://www.pediatrics.org/ cgi/content/full/108/1/e11; asthma, Native Americans, Navajo, perceptions, treatment, medication, health utilization.ABBREVIATION. ED, emergency department.

Patients’ Beliefs and Preferences Regarding Doctors’ Medication Recommendations

“…[26][27][28][29] Differences in health beliefs and use of alternative therapies may explain some differences found in adherence rates for special populations. [30][31][32] Replicating this study in special populations could yield novel and clinically useful results. The vignette also may have primed participants to respond to questions differently than they would have without the vignette.…”

Predictors of asthma medication nonadherence

“…32 Our measure of perceived control did not demonstrate an association with IBA use. Other factors that have been associated with asthma medication nonadherence are beliefs about asthma, 33,34 doubts about the usefulness of ICS medications, 32 fear of side effects, [35][36][37][38] and, among African-Americans, distrust of the health care system. 38,39 However, many of these studies were done in samples of children with asthma or their parents.…”

Medication Use in Children with Asthma: Not a Child Size Problem

“…Additionally, studies highlighted that many parents have a poor understanding of medications and how they work and often fail to use medications and devices correctly (30)(31)(32). Specifically, parental fears and beliefs about the use of oral and inhaled corticosteroids (known as "steroid phobia") are barriers to medication adherence and optimal asthma control (32)(33)(34)(35). Studies found that the inability of parents to recognize symptoms and initiate medications at appropriate times often leads to the worsening of a child's condition and overall lack of asthma control (33,25).…”