Abstract
Adolescents with asthma endorse psychosocial difficulties as barriers to inhaled corticosteroid adherence. This study examined patterns of variability in adherence and within-person associations of psychosocial variables with adherence across days. Participants included twenty-five adolescents (Mage = 14.7, SD = 1.68; 48% male) with persistent asthma. We measured adherence via electronic monitoring. Adolescents completed daily surveys measuring asthma symptoms, stress, mood, and affect. We examined within-person differences in the effect of symptoms and psychosocial variables on adherence. Adherence decreased over time. The addition of a random slope improved model fit (− 2ΔLL(1) = 9.36, p < .01). Greater asthma symptoms were significantly associated with higher adherence at the within-person level and with lower adherence between persons. We observed evidence of individual differences in the associations of stress and affect with adherence. Within-person, day-level fluctuations in adherence occur. Symptoms and psychosocial variables may influence adherence. Individually tailored interventions may effectively address nonadherence.
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modified from Eldridge and colleagues (2016) and adapted to the current pilot study)
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Availability of Data and Material
At present, institutional restrictions do not permit us to deposit our data in a public repository.
Code Availability
Python code for the adherence data cleaning tool used in analyses can be obtained by contacting Dr. Fedele (dfedele@phhp.ufl.edu).
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Acknowledgements
We wish to thank Felipe Faria, Computer Science student at the University of Florida, for creating an adherence data cleaning tool for analyses. Preliminary findings were presented at the 2018 American Psychological Association Annual Convention and the 2019 Society of Pediatric Psychology Annual Conference.
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This work was supported by a 2018 American Psychological Association of Graduate Students Psychological Science Research Grant and the University of Florida Center for Pediatric Psychology and Family Studies.
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Ms. Sweenie and Drs. Cushing, Prabhakaran, and Fedele contributed to study conception and design. Material preparation, data collection, and data cleaning were performed by Ms. Sweenie. Dr. Fleming contributed to statistical analysis. The initial manuscript draft was written by Ms. Sweenie. All authors commented on and contributed to previous versions of the manuscript; all authors read and approved the final manuscript herein.
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Sweenie, R., Cushing, C.C., Fleming, K.K. et al. Daily adherence variability and psychosocial differences in adolescents with asthma: a pilot study. J Behav Med 45, 148–158 (2022). https://doi.org/10.1007/s10865-021-00247-5
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DOI: https://doi.org/10.1007/s10865-021-00247-5