Compliance with a medical regimen for asthma: a test of the health belief model

Findings are presented from research which attempted to test the ability of a particular decision-making framework, the health belief model (HBM), to explain mothers' differential compliance with a drug regimen prescribed for their asthmatic children. Interviews were completed with 111 mothers from a low-income, clinic population, who brought their children to a pediatric emergency facility for treatment of acute asthma episodes. Based on the HBM's sociobehavioral dimensions, the interview included questions about the mother's general health motivations and attitudes, as well as about her view regarding the child's asthma condition and its ramifications. Two measures of compliance were employed: (a) laboratory verification of the drug's presence or absence in the patient's blood and (b) a construction combining objectively determined and self-reported information if laboratory documentation was unavailable. Significant associations were obtained between the majority of HBM components and the measures of compliance. Mothers' perceptions of threat of illness (particularly the child's susceptibility to illness and the seriousness of such conditions, whether asthma-related or not) and of difficulties associated with administration of the medication were substantial predictors of adherence. An unexpected finding, that adherent mothers are both more skeptical of, yet more dependent upon, physicians and medical care is explained in terms of hypotheses specific to the condition studied. Of those variables suggested by relevant literature (but unspecified in the HBM), only mothers' marital status and level of formal education maintained significant associations with compliance. These results offer additional support for the HBM approach to understanding health-related behaviors. On the basis of the findings, it is also suggested that there are no profound changes in health beliefs when compliance 'fails'.