Predicting adherence to prophylactic medication in adolescents with asthma: an application of the ASE-model

Abstract

An explanatory framework, referred to as the attitude/social influence/self-efficacy-model (ASE-model), was utilised to explain future self-reported adherence of adolescents to daily inhaled prophylactic asthma medication. The objective was to investigate the long-term influence of these earlier reported cognitive variables and other psychological and medical determinants on self-reported adherence 1 year later. Data were collected, via a questionnaire, from 86 adolescents with asthma (aged 11 through 18 years) recruited from outpatient clinics. Adherence was assessed by asking the patients to give themselves a report mark for adherence. The results of the multiple regression analyses showed that the three major ASE-variables were predictors of self-reported adherence to a moderate degree (R(2)=0.21). Previous self-reported adherence was found to be the best predictor of self-reported adherence to prophylactic asthma medication 1 year later (R(2)=0.45). The results of this study could be useful in the development of interventions to enhance adherence to asthma medication. In future, such interventions should focus on feelings of shame about having asthma and promoting healthy habits, such as adherence to medication.

Association of Asthma Self-efficacy to Asthma Control and Quality of Life

“…However, improved self-management of asthma relies upon several behavioral factors (e.g., daily symptom monitoring, treatment adherence) that may be influenced by asthma self-efficacy (ASE) [1,4], which reflects a patient's confidence in their ability to carry out the necessary selfmanagement behaviors required to control asthma symptoms and prevent exacerbations [5]. Although previous studies have linked higher general self-efficacy to improved asthma self-management behaviors, including more regular use of peak-flow meters, better medication adherence, and fewer hospitalizations for asthma [6,7], we are aware of no studies to date that have assessed the association between asthma-specific self-efficacy and levels of asthma control. Moreover, we are aware of only two studies to date to assess the impact of self-efficacy on asthma-related quality of life [8,9].…”

Adherence to prophylactic asthma medication: Habit strength and cognitions

“…Although several studies have reported self-efficacy as an important predictor of PAM adherence in patients with asthma, 7,21,23,26,[29][30][31] others have attached less or no influence to this factor. 14,15,32 With regard to social influence, previous research has stressed the role of social support in therapy adherence in chronic diseases in general; 33,34 however, this is not yet clear with regard adherence to PAM.…”

“…Deenen 26 found that adult patients with the opinion that important others (partner, children, doctor, friends, family, and colleagues) expect them to follow the prescribed PAM (ie, social norm) are more likely to adhere. According to Van Es et al, 30 however, patients are less likely to adhere if they perceive a strong normative influence of their doctor to follow the PAM prescriptions. This was only the case if previous behavior (the extent to which the patient already used PAM the year before the measurement) was included.…”

“…[37][38][39][40][41] Indications for the importance of habit strength in the context of adherence to medication are given in previous studies that showed "forgetfulness to take the medication" to be the most important reason for nonadherence, 15,25 and that a medication routine is necessary for successful medication adherence. 6,18 Van Es et al's 30 longitudinal study reported the significance of previous behavior as a predictor of adherence to PAM Deenen 26 also emphasized the importance of previous behavior in the explanation of adherence to PAM, although this was not studied.…”

Beliefs, perceptions and practices about asthma among Iranian asthma patients

“…It is well accepted that patients' views should be taken into account during medical decision-making, particularly in diseases such as asthma [4]. In addition, patients' beliefs about their illness play a key role in determining their adherence to treatment [5], which is an important aspect of self-management [6].…”