The present small grant application proposes an investigation of developmental aspects of adherence to pediatric asthma regimens, in order to identify psychological factors pertinent to asthma adherence and ultimately allow the design of developmentally appropriate interventions for improved adherence. Research in childhood chronic illness has indicated that adherence often decreases with age, although few studies have investigated the process that may account for this phenomenon. The present study proposes to assess developmental differences in medication adherence by assessing the interactive effects of the child's developmental concepts of illness and degree of responsibility for asthma management in predicting adherence to asthma regimens, and to evaluate the role of asthma self-efficacy as a mediator in the prediction of asthma adherence from developmental concepts of illness and degree of responsibility for asthma management. One hundred children and adolescents with asthma, aged 10-18, will be interviewed to assess their developmental concepts of illness. Each child participant and a parent will complete questionnaires regarding asthma self-efficacy, prescribed medication regimen, and child responsibility for asthma tasks. Children will participate in a 2-month adherence assessment in which an MDI chronolog device is attached to their regular MDI inhaler(s). It is expected that: 1) developmental concepts of illness will interact with the child's degree of responsibility for asthma care to predict adherence to inhaled medications, and 2) the relationship between developmental illness concepts, asthma responsibility, and adherence to inhaled medications will ge mediated by asthma self-efficacy. Techniques of Multiple Regression will be used to examine relations between variables. It is expected that the proposed study will further the establishment of appropriate developmental guidelines for asthma care, and begin to identify critical periods in child development for increased education and intervention in pediatric asthma.
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