Compliance with a Medical Regimen for Asthma: A Test of the Health Belief Model

• Published in: Public health reports (1974) 1978-05, Vol.93 (3), p.268-277
• Main Authors: Becker, Marshall H., Susan M. Radius, Rosenstock, Irwin M., Drachman, Robert H., Kenneth C. Schuberth, Katherine C. Teets
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Asthma; Asthma - drug therapy; Attitude to Health; Child; Child, Preschool; Children; Diseases; Female; Humans; Infant; Medication adherence; Medication administration; Medications; Middle Aged; Models, Psychological; Mothers; Patient Compliance; Physicians; Tests of compliance; Theophylline - therapeutic use
• ISSN: 0033-3549; 1468-2877

Increased empirical attention is presently being directed to the study of personal health behaviors and, in particular, to psychosocial factors impinging upon individuals' acceptance and following of therapeutic advice. Research has, however, typically focused upon treatments of reasonably constant and considerable effectiveness, avoiding disease states in which patients are advised to adhere to regimens of only uncertain efficaciousness. Asthma is such a condition; taking the theophylline-based medication as directed does not preclude the possibility of recurrent attacks. Accordingly, in this paper findings are presented from research which attempted to test the ability of a particular decision-making framework, the health belief model (HBM), to explain mothers' differential compliance with a drug regimen prescribed for their asthmatic children. Interviews were completed with 111 mothers from a low-income, clinic population, who brought their children to a pediatric emergency facility for treatment of acute asthma episodes. Based on the HBM's socio-behavioral dimensions, the interview included questions about the mother's general health motivations and attitudes, as well as about her view regarding the child's asthma condition and its ramifications. Two measures of compliance were employed: (a) laboratory verification of the drug's presence or absence in the patient's blood and (b) a construction combining objectively determined and self-reported information if laboratory documentation was unavailable. Significant associations were obtained between the majority of HBM components and the measures of compliance. Mothers' perceptions of threat of illness (particularly the child's susceptibility to illness and the seriousness of such conditions, whether asthma-related or not) and of difficulties associated with administration of the medication were substantial predictors of adherence. An unexpected finding, that adherent mothers are both more skeptical of, yet more dependent upon, physicians and medical care is explained in terms of hypotheses specific to the condition studied. Of those variables suggested by relevant literature (but unspecified in the HBM), only mothers' marital status and level of formal education maintained significant associations with compliance. These results offer additional support for the HBM approach to understanding health-related behaviors. On the basis of the findings, it is also suggested that there are no profound changes in he