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

ObjectiveMany 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.MethodsQualitative 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.ResultsTwelve 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.ConclusionsConcordance 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 ImplicationsEfforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.