Evaluating Three Methods of Assessing Adherence to an Inhaled Corticosteroid Regimen for Pediatric Asthma

Abstract

The effects of nonadherence to treatment regimens for pediatric chronic illnesses are significant. There are several characteristics of asthma therapy that make non-adherence likely. Accurate assessment of adherence is crucial, but difficult. The primary objective of this study was to examine the relationship between three methods of assessing adherence to inhaled corticosteroid treatment for pediatric asthma. This study utilized the baseline data from a randomized controlled trial for improving adherence (Kamps et al., 2008). Participants included 22 males and 25 females with asthma (72% Caucasian, mean age = 10.34 years). Adherence measures included parent and child self-report questionnaires, parent and child 24-hour recall interviews, and electronic monitors (EM). Mean adherence according to EM for this sample (67.21%) was significantly greater than 50%, the typical level for adherence to regimens for chronic pediatric diseases (Rapoff, 2010). Thus, this study provides information about moderate (as opposed to severe) difficulties with nonadherence. Results suggested that self-report methods inflate adherence compared to EM. Sensitivity, specificity, positive predictive value, and negative predictive value were assessed for each method. The self-report methods did not demonstrate sufficient psychometric properties to justify their use as stand-alone measures of adherence. Agreement between parent and child reports was high, but not redundant. These findings call for further research investigating ways that methods of assessment may be effectively combined for an accurate measurement of adherence.