Self-reported Inhaled Corticosteroid Adherence, Inhaled Corticosteroid Beliefs, and Endorsement of Nonpharmacologic Management of Asthma Among Black Adults Enrolled in a Randomized Clinical Trial in Federally Qualified Health Centers

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Abstract Rationale: Inhaled corticosteroid (ICS) use is lower in Black adults relative to White adults, even when access to treatment is equal. Lower adherence has been shown to be associated with negative ICS beliefs and a preference for non-pharmacologic treatments. However, these topics are not routinely addressed at medical appointments, leaving primary care providers unaware of why asthma control may be suboptimal. This study describes beliefs regarding pharmacologic (ICS) and non-pharmacological asthma management among Black adults and explores associations between these beliefs and adherence. Methods: We utilized baseline data from a randomized control trial of a brief shared decision-making intervention. Participants (n=106) were Black (self-reported) adults with uncontrolled asthma receiving care at one of four federally qualified health centers (FQHCs) in New York and New Jersey participating in the BREATHE (BRief Evaluation of Asthma THErapy) study. BREATHE is an efficacy-implementation randomized control trial testing a brief shared decision-making intervention that uses motivational interviewing (n =100) against a dose-matched attention control condition (n =100). Participants completed the Medication Adherence Report Scale – Asthma (MARS-A; Likert scale range= 1-5; higher score=higher self-reported adherence; scores < 4.5=poor adherence) and the Conventional and Alternative Management for Asthma questionnaire (CAM-A; two subscales= endorsement of non-pharmacologic treatments (i.e. CAM beliefs; range=1-9) and negative ICS beliefs (range=1-6) where higher scores indicate greater endorsement of CAM beliefs or negative ICS beliefs). We used linear regression to explore associations between adherence and beliefs. Results: See Table 1 for sociodemographic characteristics. Average MARS-A score was 3.53 (SD=0.74); most (75%) participants reported suboptimal adherence. As shown in Table 1, participants endorsed 4.8 of 9 non-pharmacologic asthma self-management behaviors and 2.7 of 6 negative ICS beliefs. Adherence was significantly associated with endorsement of CAM beliefs (β=-0.10; p=.04) and negative ICS beliefs (β=-0.13; p=.01). However, they were not deemed clinically meaningful due to small regression coefficients. Conclusion: Black adults with uncontrolled asthma enrolled in the BREATHE trial reported poor ICS adherence, negative ICS beliefs and a preference for non-pharmacologic approaches to asthma at study enrollment. These beliefs represent modifiable risk factors that have the potential to be improved through the BREATHE intervention.

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