Patterns of concordance and non-concordance with clinician recommendations and parents' explanatory models in children with asthma

Patient Educ Couns. 2008 Mar;70(3):376-85. doi: 10.1016/j.pec.2007.11.007. Epub 2007 Dec 26.


Objective: Many children with asthma do not take medications as prescribed. We studied parents of children with asthma to define patterns of non-concordance between families' use of asthma controller medications and clinicians' recommendations, examine parents' explanatory models (EMs) of asthma, and describe relationships between patterns of non-concordance and EM.

Methods: Qualitative study using semi-structured interviews with parents of children with persistent asthma. Grounded theory analysis identified recurrent themes and relationships between reported medication use, EMs, and other factors.

Results: Twelve of the 37 parents reported non-concordance with providers' recommendations. Three types of non-concordance were identified: unintentional--parents believed they were following recommendations; unplanned--parents reported intending to give controller medications but could not; and intentional--parents stated giving medication was the wrong course of action. Analysis revealed two EMs of asthma: chronic--parents believed their child always has asthma; and intermittent--parents believed asthma was a problem their child sometimes developed.

Conclusions: Concordance or non-concordance with recommended use of medications were related to EM's and family context and took on three different patterns associated with medication underuse.

Practice implications: Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.

MeSH terms

  • Asthma* / drug therapy
  • Asthma* / etiology
  • Boston
  • Causality
  • Child
  • Child, Preschool
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intention
  • Medication Errors / methods
  • Medication Errors / psychology
  • Medication Errors / statistics & numerical data
  • Models, Psychological*
  • Nursing Methodology Research
  • Parents / education
  • Parents / psychology*
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Qualitative Research
  • Self Administration / methods
  • Self Administration / psychology
  • Severity of Illness Index
  • Surveys and Questionnaires