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Beliefs about asthma and complementary and alternative medicine in low-income inner-city african-american adults

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Abstract

BACKGROUND: The gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities, alternative beliefs and behaviors need to be identified.

OBJECTIVE: To identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine (CAM) use in low-income African-American (AA) adults with severe asthma.

DESIGN: Qualitative analysis of 28 in-depth interviews.

PARTICIPANTS: Twenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident.

APPROACH: Transcripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach.

RESULTS: Sixty-four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty-three percent of participants reported nonadherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals (93%) willingness to use prescription medication. Three possibly dangerous CAM were identified.

CONCLUSIONS: Clinicians should be aware of patient-generated causal models of asthma and use of CAM in this population. Discussing patients’ desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient-provider partnerships and treatment fidelity.

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References

  1. Centers for Disease Control [CDC] (1998). Surveillance for asthma—United States—1960–1995. Morbid Mortal Wkly Rep. 1998;47(suppl 1):1–28.

    Google Scholar 

  2. Smedley BD, Stith AY, Nelson AR (eds.) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.

    Google Scholar 

  3. Lang DM, Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994;331:1542–6.

    Article  PubMed  CAS  Google Scholar 

  4. Halfon N, Newscheck FW. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics. 1993;91:56–61.

    PubMed  CAS  Google Scholar 

  5. Kattan M, Mitchell H, Eggleston P, et al. Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study. Pediatr Pulm. 1997;24:253–62.

    Article  CAS  Google Scholar 

  6. Halterman JS, Yoos HL, Kaczorowski JM, et al. Providers underestimate symptom severity among urban children with asthma. Arch Pediatr Adol Med. 2002;156:141–6.

    Google Scholar 

  7. Halterman JS, Aligne CA, Auinger P, et al. Inadequate therapy for asthma among children in the United States. Pediatrics. 2000;105:272–6.

    PubMed  CAS  Google Scholar 

  8. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics 2002 (EPR—Update 2002). (Publication No. 02-5075). Bethesda, MD: National Institutes of Health; 2002.

    Google Scholar 

  9. Garrett J, Kolbe J, Richards G. Major reduction in asthma morbidity in New Zealand: what lessons have been learned? Thorax. 1995;50:303–11.

    Article  PubMed  CAS  Google Scholar 

  10. Isihara K, Hasegawa T, Okazaki M, et al. Long-term follow-up of patients with a history of near fatal episodes: can inhaled corticosteroids reduce the risk of death from asthma? Int Med. 1995;34:77–80.

    Google Scholar 

  11. Apter AJ, Boston RC, George M, et al. The potentially modifiable barriers to adherence: it’s not just black and white. J Allergy Clin Immunol. 2003;111:1219–26.

    Article  PubMed  Google Scholar 

  12. Gottlieb DJ, Beiser AS, O’Connor G. Poverty, race, and medication use are correlates of asthma hospitalization rates: a small area analysis in Boston. Chest. 1995;108:28–35.

    PubMed  CAS  Google Scholar 

  13. Hufford DJ. Contemporary community-based practices. In: Gevitz N, ed. Other Healers. Baltimore: Johns Hopkins University Press; 1988;228–64.

    Google Scholar 

  14. National Center for Complementary and Alternative Medicine. What Is Complementary and Alternative Medicine (CAM)? Available at: http://nccam.nih.gov/health/whatiscam. Accessed December 1, 2002.

  15. Barnes PM, Powell-Griner E, McFann K, et al. Complementary and Alternative Medicine Among Adults: United States, 2002. Advance Data From Vital and Health Statistics; No 343. Hyattsville, MD: National Center for Health Statistics; 2004.

    Google Scholar 

  16. WHO. Traditional medicine strategy 2002–2005. Geneva: World Health Organization; 2002.

    Google Scholar 

  17. Cuzzolin L, Zaffani S, Murgia V, et al. Patterns and perceptions of complementary/alternative medicine among paediatricians and patients’ mothers: a review of the literature. Eur J Pediatr. 2003;62:820–7.

    Article  Google Scholar 

  18. Langhorst J, Anthonisen IB, Steder-Neukamm U, et al. Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey. Inflam Bowel Dis. 2005;11:287–95.

    Article  Google Scholar 

  19. Wheaton AG, Blanck HM, Gizlice Z, Reyes M. Medicinal herb use in a population-based survey of adults: prevalence and frequency of use. reasons for use, and use among their children. Ann Epidemol. 2005;15:678–85.

    Article  Google Scholar 

  20. Canales MK, Geller BM. Surviving breast cancer: the role of complementary therapies. Fam Comm Health. 2003;26:11–24.

    Google Scholar 

  21. Mills E, Ernst E, Singh R, Ross C, Wilson K. Health food store recommendations: implications for breast cancer patients. Breast Cancer Res. 2003;5:R170–4.

    Article  PubMed  Google Scholar 

  22. Eisenberg DM, Kessler RC, Von Rompany MI, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Int Med. 2001;135:344–51.

    PubMed  CAS  Google Scholar 

  23. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: critical lessons from anthropologic and cross-cultural research. Ann Int Med. 1978;88:251–8.

    PubMed  CAS  Google Scholar 

  24. Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271:690–4.

    Article  PubMed  CAS  Google Scholar 

  25. Lincoln Y, Guba E. Naturalistic Inquiry. Thousand Oaks, CA: Sage Publications; 1985.

    Google Scholar 

  26. Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications; 2002.

    Google Scholar 

  27. George M, Freedman TG, Norfleet AL, Feldman HI, Apter AJ. Qualitative research-enhanced understanding of patients’ beliefs: results of focus groups with low-income, urban, African American adults with asthma. J Allergy Clin Immunol. 2003;111:967–73.

    Article  PubMed  Google Scholar 

  28. George M, Apter AJ. Gaining insights into patients’ beliefs using qualitative research methodologies. Curr Opin Allergy Clin Immunol. 2004;4:185–9.

    Article  PubMed  Google Scholar 

  29. Giacomini MK, Cook DJ. Users’ guide to the medical literature: XXIII Qualitative research in health care B: What are the results and how do they help me care for my patients? Evidence-based Medicine Working Group. JAMA. 2000;284:478–82.

    Article  PubMed  CAS  Google Scholar 

  30. Blanc PD, Kuschner WG, Katz PP, Smith S, Yelin EH. Use of herbal products, coffee or black tea, and over-the-counter medications as self-treatments among adults with asthma. J Allergy Clin Immunol. 1997;100:789–91.

    Article  PubMed  CAS  Google Scholar 

  31. Michael JB, Sztajnkrycer MD. Deadly pediatric poisons: nine common agents that kill at low doses. Emerg Med Clin North Am. 2004;22:1019–50.

    Article  PubMed  Google Scholar 

  32. Pharmacist’s Letter/Prescriber’s Letter. The updated therapeutic use of herbs. Part 1. Stockton, CA, 2000, March 15.

  33. Kaptchuk TJ, Eisenberg DM. Varieties of healing. 1: medical pluralism in the United States. Ann Int Med. 2001;135:196–204.

    PubMed  CAS  Google Scholar 

  34. Snell LM, Wilson RP, Offinger KC, et al. Patient and physician explanatory models for acute bronchitis. J Fam Pract. 2002;51:1035–40.

    PubMed  Google Scholar 

  35. Arcury TA, Skelly AH, Gesler WM, et al. Diabetes meanings among those without diabetes: explanatory models of immigrant Latinos in rural North Carolina. Soc Sci Med. 2004;59:2183–93.

    Article  PubMed  Google Scholar 

  36. Karasz A. Cultural differences in conceptual models of depression. Soc Sci Med. 2005;60:1625–35.

    Article  PubMed  Google Scholar 

  37. Bara AI, Barley EA. Caffeine for asthma. Cochrane Database of Systematic Reviews. 2000;4.

  38. Nair B. Final report on the safety assessment of Mentha Piperita (Peppermint) Oil, Mentha Piperita (Peppermint) Leaf Extract, Mentha Piperita (Peppermint) Leaf, and Mentha Piperita (Peppermint) Leaf Water. Int J Toxins. 2001;20(suppl 3):61–73.

    Google Scholar 

  39. Krishnan JA, Riekert KA, McCoy JV, et al. Corticosteroid use after hospital discharge among high-risk adults with asthma. Am J Respir Crit Care Med. 2004;170:1281–5.

    Article  PubMed  Google Scholar 

  40. Choo PW, Rand CS, Inui TS, Lee ML, Canning C, Platt R. A cohort study of possible risk factors for over-reporting of antihypertensive adherence. BMC Cardiovasc Dis. 2001;1:6.

    Article  CAS  Google Scholar 

  41. Bender B, Wamboldt FS, O’Connor SL, et al. Measurement of children’s asthma medication adherence by self report, mother report, canister weight, and Doser CT. Ann All Asthma Immunol. 2000;85:416–21.

    Article  CAS  Google Scholar 

  42. George M, Birck A, Feldman H, Apter A. Is two-week recall of inhaled steroid adherence accurate? Am J Respir Crit Care Med. 2002;165:A198.

  43. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Int Med. 2005;165:1749–55.

    Article  Google Scholar 

  44. Helman CG. Culture, Health and Illness. 3rd edn. Oxford, UK: Butterworth-Heinemann; 101–45.

  45. The Gallup Poll. Nurses top list in honesty and ethics poll. Available at: http://www.gallup.com/poll/. Accessed August 11, 2005.

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Authors and Affiliations

  1. Johns Hopkins University School of Nursing, 525 N. Wolfe St, 21205, Baltimore, MD

    Maureen George PhD, RN, AE-C

  2. Division of Family Child Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Kathleen Birck FNP, RN

  3. Department of Humanities, Penn State College of Medicine, Hershey, PA, USA

    David J. Hufford PhD

  4. Division of Family Community Health and Center for Health Disparities Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Loretta Sweet Jemmott PhD, RN, FAAN

  5. Division of Biobehavioral and Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Terri E. Weaver PhD, RN, CS, FAAN

Authors
  1. Maureen George PhD, RN, AE-C
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  2. Kathleen Birck FNP, RN
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  3. David J. Hufford PhD
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  4. Loretta Sweet Jemmott PhD, RN, FAAN
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  5. Terri E. Weaver PhD, RN, CS, FAAN
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Corresponding author

Correspondence to Maureen George PhD, RN, AE-C.

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No conflicts of interest to declare.

Support: National Center for Complementary and Alternative Medicine, Individual National Research Service Award (1F31AT1149-01), National Institutes of Health and the American Lung Association’s Lung Health Dissertation Award.

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George, M., Birck, K., Hufford, D.J. et al. Beliefs about asthma and complementary and alternative medicine in low-income inner-city african-american adults. J GEN INTERN MED 21, 1317–1324 (2006). https://doi.org/10.1111/j.1525-1497.2006.00624.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00624.x

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