African Americans Want a Focus on Shared Decision-Making in Asthma Adherence Interventions
Background and Objective
Inhaled corticosteroids (ICS) reduce asthma-related morbidity and mortality. However, ICS non-adherence is more common in African American (AA) adults than White adults and explains, in part, the marked asthma disparities that AAs experience. We aimed to understand how ICS non-adherence could be addressed from the perspective of AA adults with asthma, their family, and friends.
We held six focus groups at two urban federally qualified health centers separately with adult asthma patients (n = 2), patients’ family/friends (n = 2), and patients and family/friends together (n = 2). Qualitative descriptive methodology guided the design and the conduct of focus groups. Verbatim transcripts were analyzed by three coders working independently using conventional content analysis to capture responses to interview questions and identify emergent categories.
Forty-six AA adults participated (32 patients, 14 family/friends); 67% were female. Participants stated that ICS adherence could be improved if they were heard, respected, and received patient-centered care, and if providers highlighted the risk of ICS non-adherence at clinic visits. Though not explicitly described by participants as shared decision-making (SDM), what they described included many essential elements of SDM.
Participants desired SDM and offered reasons for ICS non-adherence that could be used to inform an SDM intervention for clinical application. Strategies informed by the recipients of care and delivered by providers during routine office visits offer a scalable approach to narrowing asthma disparities experienced by AA adults.
ClinicalTrials.gov identifier NCT03036267.
We would like to thank Hyejin Jeon, Dr. Richard Dorritie, and Dr. Aluem Tark for their assistance in data collection and note-taking during the focus groups.
All authors have drafted the work and/or revised it critically for important intellectual content and have given final approval of the version to be published, and agree to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. In addition, specific contributions are noted as follows: MG—conception or design of the work; acquisition, analysis, and interpretation of data for the work; AA—analysis and interpretation of data for the work; AC—acquisition, analysis, and interpretation of data for the work; DC—analysis and interpretation of data for the work; J-MB—conception or design of the work; acquisition, analysis, and interpretation of data for the work.
Compliance with Ethical Standards
This study was funded by the National Institute of Nursing Research/National Institutes of Health (1 R21 NR016507, principal investigator Maureen George).
Conflict of interest
Dr. George is a consultant to AstraZeneca, Mylan, and Teva. No conflicts exist for Drs. Arcia and Bruzzese or Ms. Chung and Ms. Coleman.
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