Adherence to daily controller medication in pediatric asthma
James, Carrah Lei
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This dissertation was undertaken with two related aims. First, a review of the literature was conducted to determine existing theoretical frameworks suitable for studying medical treatment adherence in children with chronic illness. Four models of health behavior with sufficient research to make reasonable inferences regarding potential utility of application to pediatric adherence were identified: (a) Transtheoretical model, (b) Social-Cognitive theory, (c) Health Belief model, and (d) the Theory of Planned Behavior (TPB). Each model offers theoretical and practical advantages and disadvantages. While much research using these four models has been generated, little has been achieved toward validating a unified framework for adherence research in children with chronic illness. Of the four models reviewed, the Theory of Planned Behavior appears to hold the most promise as a theoretical framework for medical treatment adherence in children for the following reasons: (a) the TPB possesses an extensive literature including explicit guidance for methodological integrity, (b) results of previous studies suggest that TPB variables are significantly predictive for a number of health behaviors, and (c) parsimony of design lends itself to practical research and application. The second aim of this dissertation was to determine whether the TPB model demonstrates utility as a framework for adherence behavior of children with asthma, the most prevalent pediatric chronic illness. A descriptive study was conducted using self-report questionnaires to measure children‟s attitudes, subjective norms, perceived behavioral control (PBC), intentions, and adherence behavior. Relationships between variables were analyzed using two multiple regression models aligned with TPB theoretical predictions. Findings provided general support for the overall model; however, PBC was the only significant independent predictor of Intention, and Intention was the only significant independent predictor of self-rated adherence behavior. Results suggest that the TPB provides a sturdy foundation on which to build a more comprehensive framework for explaining and predicting adherence in children with asthma; however, the TPB will likely require modifications to achieve clinically useful explanatory/predictive power in this population. The constructs of subjective norm and PBC in particular, may require developmentally-tailored operationalization and/or differing methods of assessment (e.g., measures of perspective-taking, parent variables, perceived responsibility) in children.