Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Caregivers' adherence factors affecting maintenance treatment in children with well-controlled asthma : A qualitative analysis through in-depth interview

천식 조절 상태 환아의 유지 치료에 대한 보호자 순응 요인: 심층 면담을 통한 질적 분석

  • Choi, Ic Sun (Environmental Research Center, Korea University Anam Hospital,Department of Pediatrics, Mokpo Hansarang Hospital) ;
  • Cho, Saeng Koo (Department of Pediatrics, Mokpo Hansarang Hospital) ;
  • La, Kyong Suk (Department of Pediatrics, College of Medicine, Korea University) ;
  • Byeon, Jung Hye (Department of Pediatrics, College of Medicine, Korea University) ;
  • Song, Dae Jin (Environmental Research Center, Korea University Anam Hospital,Department of Pediatrics, College of Medicine, Korea University) ;
  • Yoo, Young (Environmental Research Center, Korea University Anam Hospital,Department of Pediatrics, College of Medicine, Korea University) ;
  • Choung, Ji Tae (Environmental Research Center, Korea University Anam Hospital,Department of Pediatrics, College of Medicine, Korea University)
  • 최익선 (고려대학교 안암병원 환경보건센터,목포한사랑병원 소아청소년과) ;
  • 조생구 (목포한사랑병원 소아청소년과) ;
  • 라경숙 (고려대학교 의과대학 소아과학교실) ;
  • 변정혜 (고려대학교 의과대학 소아과학교실) ;
  • 송대진 (고려대학교 안암병원 환경보건센터,고려대학교 의과대학 소아과학교실) ;
  • 유영 (고려대학교 안암병원 환경보건센터,고려대학교 의과대학 소아과학교실) ;
  • 정지태 (고려대학교 안암병원 환경보건센터,고려대학교 의과대학 소아과학교실)
  • Received : 2009.11.25
  • Accepted : 2010.02.08
  • Published : 2010.03.15
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Abstract

Purpose : Good adherence of caregivers is essential for successful health outcomes in the treatment of childhood asthma. The purpose of this study was to identify the factors contributing to good adherence of maintenance treatment in children with well-controlled asthma. Methods : Children with well-controlled asthma being treated with a daily controller for at least 3 months in Korea University Anam Hospital were selected. Their caregivers who had good adherence to maintenance treatment were recruited. Qualitative study through in-depth interviews was conducted with 18 caregivers who agreed to the study. Results : The 18 caregivers (mean age, 40.0 years) consisted of 15 mothers, 2 grandmothers, and 1 father. The resulting consensus were identified and grouped into 2 domains: the caregiver/patient aspect with 8 theme factors and the treatment aspect with 4 theme factors. The main theme factors in the caregiver/patient aspect were enabling participation in physical activities and exercise (77.8%), perceptions regarding asthma and the need for long-term treatment (50.0%), and perceived value of the medications outweighing the risk of side effects (38.9%). The main theme factors in the treatment aspect were trust in the physician (77.8%), general satisfaction with the manner and attitude of the physician (77.8%) and verification of the necessity of further treatment by performing tests (38.9%). Conclusion : Efforts to improve caregivers' adherence to the treatment of childhood asthma must include a range of factors related to both caregiver/patient aspects and treatment aspects. Among all of these factors, it may be most important to establish a physician-caregiver partnership.

목 적: 성공적인 천식 치료를 위해서는 증상이 조절된 이후에도 일정 기간의 유지 치료가 지속되어야 하며, 이를 위해서는 소아 환자의 경우 보호자의 순응도가 매우 중요하다. 본 연구는 천식 조절상태 환아의 보호자가 장기간의 유지 치료에 순응하는 데 관련된 요인을 알아보고자 하였다. 방 법: 고려대학교 안암병원 소아청소년과에서 천식으로 진단하여 유지 치료를 받고 있는 환아 중에서 NAEPP 가이드라인에 따른 천식 조절상태가 최소 3개월 이상 유지되면서 치료 순응도가 높은 보호자 18명을 대상으로 하였다. 질적 분석 방법 중 하나인 심층 면담을 통해 보호자들의 천식 치료와 관한 경험, 천식 및 천식 치료에 대한 인식, 치료자와의 상호 관계에 대한 자료를 얻고, 이들의 높은 치료 순응도와 관련된 요인들을 분석하였다. 결 과: 총 18명의 보호자(어머니 15명, 아버지 1명, 할머니 2명)가 심층 면담에 참여하였고 이들의 평균 연령은 40.0세였다. 심층면담 결과 보호자 및 환자 영역에 해당하는 8개의 순응 요인과 치료 영역에 해당하는 4개의 순응 요인이 밝혀졌다. 보호자 및 환자 영역에서는 천식 치료 후 증상 호전에 따른 일상활동의 수행(77.8%), 천식의 장기간 치료 필요성에 대한 인식(50.0%), 부작용보다 우선하는 치료제의 필요성에 대한 가치 인식(38.9%) 등이 주로 언급되었다. 치료 영역에서 가장 흔히 언급된 요인은 치료자에 대한 신뢰(77.8%), 진료 방식 및 태도에 대한 전반적인 만족(77.8%), 객관적인 검사를 통한 지속적인 치료 필요성의 제시(38.9%)였다. 결 론: 소아 천식 치료의 순응도 향상을 위해서는 보호자/환자 측면의 요인과 치료 측면의 복합적인 작용에 대한 고려가 필요하다. 치료자로서는 보호자와의 상호 협력 관계 형성을 위한 노력이 가장 기본적으로 선행되어야 할 것으로 생각된다.

Keywords

Acknowledgement

Supported by : Ministry of Environment

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