JMIR Publications

ABSTRACT

Background:

Asthma is one of the most prevalent chronic diseases of childhood, affecting 1 in 10 children, and over 3 million Canadians. Asthma disproportionately affects children with lower socio-economic status (SES) who have higher prevalence of asthma, heavier symptom burdens, higher rates of ED visits, and hospital admissions. Controller medications such as inhaled corticosteroids (ICS) significantly reduce asthma exacerbations while improving lung function and control of asthma symptoms. Yet, a large proportion of children still have poor asthma control, in part due to suboptimal adherence, with objective adherence values ranging from 50-70% Adherence can be hindered by financial barriers that limit access to medication. In addition, behavioural factors related to low income may contribute. Unmet social needs for food, lodging, and childcare for example, may create stress and worry in parents, negatively influencing medication adherence. Precarious employment, food insecurity, and unstable housing situations are also cognitively taxing and force families to focus on immediate needs, leading to scarcity and heightening future discounting, or a tendency to attribute greater value to the present than to the future in making decisions.

Objective:

In this project, we will investigate the impact of two cognitive factors on adherence: scarcity and future discounting. This project’s overarching aim is to determine whether scarcity and future discounting are associated with medication adherence in children with asthma and explore their role in the relationship between unmet social needs and adherence.

Methods:

This 12-month prospective observational cohort study will recruit 200 families at the Asthma Clinic of the CHU Sainte-Justine, a tertiary care pediatric hospital in Montreal, Canada. Parents of children aged 2-17 years seen at CHU Sainte-Justine asthma clinic with a diagnosis of asthma will be eligible for the study. Participants will be asked to complete two questionnaires at the time of enrolment, one questionnaire at 6-month follow-up, and a final questionnaire at 12-months following recruitment. Participants will be followed for the 12 month follow up period, and their adherence to controller medication will be measured, as well as level of scarcity, future discounting, unmet social needs, and healthcare service utilisation.

Results:

Research activities in this study began in December 2021 and are ongoing. Participant enrolment and data collection are anticipated to begin in June 2022.

Conclusions:

This project will allow to document the impact of unmet social needs, scarcity, and future discounting on adherence in a diverse population of children with asthma using robust documentation of adherence and validated measures of scarcity and future discounting. This research will confirm the potential for scarcity and future discounting as novel targets for either new interventions or improving existing effective interventions to improve adherence to controller medication, and lead to reduced risk across the life course for vulnerable children with asthma. Clinical Trial: This trial has been registered on Clinicaltrials.gov