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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.

Keywords: asthma; complementary and alternative medicine (CAM); African American; health beliefs; qualitative research

Document Type: Research article

DOI: 10.1111/j.1525-1497.2006.00624.x

Affiliations: 1: Johns Hopkins University School of Nursing, Baltimore, MD, USA; 2: Division of Family Child Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; 3: Department of Humanities, Penn State College of Medicine, Hershey, PA, USA; 4: Division of Family Community Health and Center for Health Disparities Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; 5: Division of Biobehavioral and Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

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Beliefs About Asthma and Complementary and Alternative Medicine in Low-Income Inner-City African-American Adults