Maureen George1, Maxim Topaz2, Cynthia Rand3, Marilyn Lynn Sawyer Sommers4, Karen Glanz5, Michael V Pantalon6, Jun J Mao7, Judy A Shea8. 1. University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa. Electronic address: mgeorge@nursing.upenn.edu. 2. University of Pennsylvania School of Nursing, Philadelphia, Pa; University of Haifa, Haifa, Israel. 3. Johns Hopkins University School of Medicine, Baltimore, Md. 4. University of Pennsylvania School of Nursing, Philadelphia, Pa; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Global Women's Health, University of Pennsylvania School of Nursing, Philadelphia, Pa. 5. University of Pennsylvania School of Nursing, Philadelphia, Pa; Center for Health Behavior Research, University of Pennsylvania, Philadelphia, Pa; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa. 6. Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, New Haven, Conn. 7. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa. 8. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
Abstract
BACKGROUND: Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults. OBJECTIVES: This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care. METHODS: Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. RESULTS: Psychometric testing of the instrument identified 17 items representing ICS beliefs (α = .59) and CAM endorsement (α = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. CONCLUSION: Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.
BACKGROUND: Many factors contribute to uncontrolled asthma; negative inhaled corticosteroid (ICS) beliefs and complementary and alternative medicine (CAM) endorsement are 2 that are more prevalent in black compared with white adults. OBJECTIVES: This mixed-methods study (1) developed and psychometrically tested a brief self-administered tool with low literacy demands to identify negative ICS beliefs and CAM endorsement and (2) evaluated the clinical utility of the tool as a communication prompt in primary care. METHODS: Comprehensive literature reviews and content experts identified candidate items for our instrument that were distributed to 304 subjects for psychometric testing. In the second phase content analysis of 33 audio-recorded primary care visits provided a preliminary evaluation of the instrument's clinical utility. RESULTS: Psychometric testing of the instrument identified 17 items representing ICS beliefs (α = .59) and CAM endorsement (α = .68). Test-retest analysis demonstrated a high level of reliability (intraclass correlation coefficient = 0.77 for CAM items and 0.79 for ICS items). We found high rates of CAM endorsement (93%), negative ICS beliefs (68%), and uncontrolled asthma (69%). CAM endorsement was significantly associated with uncontrolled asthma (P = .04). Qualitative data analysis provided preliminary evidence for the instrument's clinical utility in that knowledge of ICS beliefs and CAM endorsement prompted providers to initiate discussions with patients. CONCLUSION: Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma. A brief self-administered instrument that identifies beliefs and behaviors that likely undermine ICS adherence might be a leveraging tool to change the content of communications during clinic visits.
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