Elsevier

Journal of Pediatric Health Care

Volume 22, Issue 4, July–August 2008, Pages 221-229
Journal of Pediatric Health Care

Original Article
Don't Ask, Don't Tell: Parental Nondisclosure of Complementary and Alternative Medicine and Over-the-Counter Medication Use in Children's Asthma Management

https://doi.org/10.1016/j.pedhc.2007.07.001Get rights and content

Abstract

Introduction

Parent–health care provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies.

Method

One-time interview and 1-year retrospective medical record review with 228 parents of 5- to 12-year-old children with asthma enrolled from six pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure.

Results

Seventy-one percent of parents reported using CAM and/or OTC medication for children's asthma management, and 54% of those parents did not disclose usage. Seventy-five percent “did not think” to discuss it. Better parent-HCP relationship led to decreased nondisclosure.

Discussion

HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children's asthma management strategies in order to arrive at a shared asthma management plan for the child, leading to improved asthma health outcomes.

Section snippets

Design

The data for these secondary analyses were derived from a study investigating the impact of parental beliefs about the nature of asthma and its treatment on the adequacy of the child's treatment regimen. The study was cross-sectional and used a one-time, semi-structured home interview of parents of children with asthma and the children themselves, and a retrospective 1-year review of the children's medical records. An additional section on CAM use was added to the parent interview as part of

Analytic Strategies

Descriptive statistics summarize nondisclosure of OTC medications and CAM use and subgroup differences by type of therapy, race, poverty, education, and symptom severity. Chi-square analyses were conducted to examine differences in nondisclosure by type of CAM/OTC medication and also the sociodemographic differences for reasons for nondisclosure.

Multinomial logistic regression analysis using maximum likelihood estimation (SAS version 9.1) examined the influence of the parent-HCP relationship on

Descriptive Statistics of Sample and CAM/OTC Use

Three parents who reported “Other” race were excluded from all analyses because the group was too small and diverse to make meaningful race-related comparisons. Table 1 shows the descriptive statistics for the sample (N = 225).

Overall, 159 of 225 parents (71%) reported ever using CAM and/or OTC therapies to manage their child's asthma. There were statistically significant differences based on race, education, poverty, and child's symptom severity between those parents who reported using CAM/OTC

Discussion

This study provides the first in-depth exploration of parental nondisclosure to HCPs of CAM and OTC medication use in pediatric asthma management. The results demonstrated that 54% of parents who used CAM and OTC medications to manage their children's asthma symptoms were not disclosing their use to their HCP. Full disclosure occurred only one third of the time, regardless of race, education, or poverty.

The reasons parents gave for nondisclosure in this study parallel what has been reported in

Study Limitations

Several limitations to this study need to be discussed. Our sample included only 17 Hispanic families, which resulted in low study power for the analyses examining racial differences in disclosure and nondisclosure. Recall bias may have been a factor because we asked parents to report on CAM and OTC medications ever used to treat their child's asthma. We thus focused on lifetime use of these therapies because the disclosure and barriers to disclosure questions were for lifetime (“ever used”).

Kimberly Sidora-Arcoleo is Assistant Professor, Arizona State University College of Nursing & Healthcare Innovation, Phoenix, Ariz.

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  • Cited by (0)

    Kimberly Sidora-Arcoleo is Assistant Professor, Arizona State University College of Nursing & Healthcare Innovation, Phoenix, Ariz.

    H. Lorrie Yoos is Professor, University of Rochester School of Nursing and Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

    Harriet Kitzman is Professor, University of Rochester School of Nursing and Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

    Ann McMullen is Associate Professor of Clinical Nursing, University of Rochester School of Nursing, Rochester, NY.

    Elizabeth Anson is Senior Information Analyst, University of Rochester School of Nursing, Rochester, NY.

    This research was funded by National Institute for Nursing Research grant No. 1RO1NR007905-01A2.

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