Asthma, Rhinitis, Other Respiratory Diseases
Relations among asthma knowledge, treatment adherence, and outcome,☆☆

https://doi.org/10.1067/mai.2003.160Get rights and content

Abstract

Background: Asthma knowledge is frequently assumed to be a prerequisite for optimal asthma treatment. However, the validity of existing asthma knowledge questionnaires has not been rigorously examined, and no contemporary measure of asthma knowledge has received widespread acceptance. Objective: To construct and examine the psychometric properties of an asthma knowledge instrument, and its association with demographic and psychosocial variables, asthma medication adherence, and treatment outcome. Methods: A 25-item Asthma Knowledge Questionnaire was developed with input from national pediatric asthma experts. Parents of 155 children with asthma completed the Asthma Knowledge Questionnaire as well as demographic, family functioning, and home environment measures. Asthma outcomes and adherence with inhaled medication was measured across 12 months. Results: Despite the many steps taken to develop a strong measure of asthma knowledge, reliability was relatively poor. There was also no association between asthma knowledge and treatment adherence or outcomes. Furthermore, asthma knowledge was not a unidimensional construct and was not a simple function of education. Conclusions: Findings from this study, in combination with previous studies of asthma knowledge questionnaires, suggest that the construction of a simple self-report asthma knowledge instrument for use as a primary outcome measure demonstrating mastery of asthma self-management skills may not be achievable. (J Allergy Clin Immunol 2003;111:498-502.)

Section snippets

Participants

All subjects participated in a large longitudinal study of family influences on childhood asthma treatment adherence and outcome. The research protocol was reviewed and approved by the National Jewish Institutional Review Board. Informed consent/assent was obtained from all participating parents and children. Subjects were recruited from two sources. These sources were selected to provide informative contrasts: the Public School sample to be more reflective of the “average” level of asthma care

Psychometric properties

Table I includes the 25 Asthma Knowledge Questionnaire items and their correct response rates. For 9 of the 25 questions, 95% or more of the parents gave the correct response. The mean parental knowledge score for this sample was 88% correct (SD = 10.5%; range = 52% to 100%).

Internal consistency reliability was low but adequate (Cronbach α = 0.69), providing marginal support that asthma knowledge as measured by this questionnaire was unidimensional. On the other hand, a principle component

Discussion

The Asthma Knowledge Questionnaire was carefully developed, drawing on previously published measures, using a panel of nationally recognized experts in pediatric asthma, and incorporating the latest practice guidelines for childhood asthma. Despite these efforts, the results suggest that the questionnaire's reliability was adequate at best. Most importantly, no association was found between scores on the questionnaire and treatment adherence or outcome. This finding suggests a problem with

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Supported by NIH grants R01-HL53391 and M01-RR00051.

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Reprint requests: Dr F. Wamboldt, A114, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206.

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