Published Online: September 2013
Poor adherence to daily inhaled corticosteroid medication is a significant risk factor for alarming rates of asthma-related emergency room visits and hospitalizations for inner-city African American and Hispanic adolescents. Interventions to increased adherence in this population are lacking. In a study published in the The Journal of Allergy and Clinical Immunology: In Practice, The Impact of Peer Support and mp3 Messaging on Adherence to Inhaled Corticosteroids in Minority Adolescents with Asthma: A Randomized Controlled Trial, Mosnaim et al. sought to leverage adolescents’ existing high media consumption, specifically listening to music on an mp3 player, to deliver a culturally sensitive intervention aimed at improving asthma medication adherence.
Sixty-eight adolescents 11-16 year of age and self-identified as African American or Hispanic, with a diagnosis of persistent asthma, prescribed a daily inhaled corticosteroid medication by their health care provider, and with an electronically measured adherence to their daily inhaled corticosteroid medication of< 47% at baseline, were invited to participate in the 10-week active treatment phase of the study. All 68 participants received asthma education, an iPod shuffle (Apple Inc, Cupertino, CA), and clean mp3 music tracks. The 34 adolescents randomized into the treatment group attended weekly coping peer group sessions, led by a social worker, to discuss barriers to adherence and strategies to overcome these difficulties. At the end of each weekly session, they would record messages for each other promoting adherence. These messages, produced with background music chosen by the teens, were placed as mp3 tracks on their iPods to be randomly shuffled among their favorite music tracks. The 34 participants randomized into the attention control group met one-on-one each week with a research assistant and did not talk about medication taking behavior. At each of these meetings, the attention control group participants received the same number of mp3 messages promoting adherence as the treatment group, but these messages were written and recorded by an asthma doctor instead of peers. These doctor-recorded messages were placed on the participants’ iPods to be played randomly in between music tracks.
Electronically measured adherence to inhaled corticosteroid medication was low at baseline, and declined further over the 10-week active treatment phase in both the treatment group and attention control group. Participant self-reported adherence at week 10 of the active treatment phase was significantly higher than objectively measured adherence across both study groups. In the treatment group, the median electronically measured adherence was 6.3%, and the median self-reported adherence was 50.0%. In the attention control group, the median electronically measured adherence was 14.3% and the median self-reported adherence was 61.6%.
Peer support and mp3 delivered coping peer asthma messages may not be of sufficient dose to increase adherence to daily inhaled corticosteroid medication among low-income minority adolescents. The discrepancies between objectively measured and self-reported adherence in this study should raise concerns. Asthma guidelines recommend monitoring patient adherence to his/her treatment plan at each visit. Reliance on self-report of adherence to inhaled corticosteroids among urban minority adolescents may give health care providers inadequate information to adjust their medication treatment regimens.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.