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

Objective: Many 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. Methods: Qualitative 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. Results: Twelve 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. Conclusions: Concordance 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 Implications: Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.