Patricia J. Bush

A Children??s Health Belief Model

The classic Health Belief Model (HBM) was adapted to explain children’s expected medicine use for five common health problems. To evaluate this Children’s Health Belief Model (CHBM), 270 urban preadolescents, stratified by socioeconomic status, grade level, and sex, and their primary caretakers (93% mothers) were individually interviewed. Analyses were performed in two steps. First, regression analysis evaluated the influence of the child’s primary caretaker on the child’s expected medicine use; Individual differences in children’s motivations, perceived benefits and threats, and expectations to take medicines were partially explained by caretakers’ perceptions of these children. Second, path analysis evaluated hypothesized causal relationships in the CHBM, accounting for 63% of the adjusted variance in children’s expected medicine use. Two readiness factors, perceived severity of illness and perceived benefit of taking medicines, had the highest path coefficients, with illness concern and perceived vulnerability to illness accounting for a smaller, but significant, portion of the variance. Cognitive/Affective variables, notably children’s health locus of control, contributed to indirect paths between demographic and readiness factors. The CHBM appears to be a promising model for studying the development of children’s health beliefs and expectations.

Pathways to medicine use.

Although path analysis has been used to explain physician and hospital use, it has never before been applied to medicine use. This analysis assesses direct and indirect relationships among predisposing, enabling and need-for-care factors on use ofprescribed and nonprescribed drugs. Data are drawn from 2378 adults in the Baltimore SMSA survey of the WHO study of medical care utilization. Principal findings in terms of direct effects are: females and whites are more likely to use both prescribed and nonprescribed medicines; age is positively related to prescribed drug use and negatively related to nonprescribed drug use. Of six enabling factors, only perceived availability of care has a significant, direct effect on drug use (positive for prescribed and inverse for nonprescribed). Perceived morbidity (a need-for-care factor) is the strongest predictor in the model on both outcome variables. Anxiety and physician visits have significant direct effects on prescribed use. The pattern of indirect effects is also discussed. Overall, the model is a better predictor of prescribed than of nonprescribed medicine use, and the analysis suggests that nonprescribed medicine use may substitute for entry into the formal medical care system.

Development and evaluation of an interactive CD-ROM for children with leukemia and their families

To meet the need for an interactive software product to educate children with leukemia, ages 4-11 years, and their families about the disease and its treatment, we developed and evaluated an interactive, comprehensive, multimedia CD-ROM product, Kidz with Leukemia: A Space Adventure. The prototype was tested using a randomized controlled experimental design. Children with leukemia and their parents were randomized to receive either the newly developed CD-ROM or the book You and Leukemia by Lynn Baker. Health care providers (HCPs) and other content/technical experts evaluated only the CD-ROM. Data were collected on childrens health locus of control, their understanding of leukemia, and the satisfaction of participants with their assigned intervention. Children in the CD-ROM group, compared with those in the book group, showed increased feelings of control over their health. Although there was a high level of satisfaction with the CD-ROM among all users, younger children and their parents were most satisfied. In conclusion, the CD-ROM, Kidz with Leukemia: A Space Adventure, was found to be a useful, engaging, and empowering tool for children with leukemia and can serve as a model for developing future health-related educational materials.

Origins and stability of children's health beliefs relative to medicine use

Two hundred and seventy urban school children and their primary caretakers (93% mothers) were interviewed in Washington, D.C., about their health beliefs and behaviors relative to medicine use and expected medicine use for common health problems to test hypotheses about the development of childrens health beliefs and behaviors. Results indicated that mothers have a stronger influence on health related orientations of children than previously indicated and that these orientations are relatively stable by school age. Strong similarities were observed between primary caretakers and their children in a health belief based model to predict expected medicine use, and significant correlations between primary caretakers and children were observed for almost three-fourths of the variables in the model; correlations were not higher between mothers and older children than between mothers and younger children, nor were means of variables closer to those of mothers for older than for younger children. Most model variables were stable for children over a 3 year period, and measurement in the earlier period predicted medicine use and expected medicine use 3 years later. Only weak developmental effects were suggested, primarily by perceived vulnerability to illness, a powerful predictor in adult representations of the Health Belief Model, but relatively weak in childrens representations.

Who's using medicines?

Data derived from a 1968–69 household survey of 3,481 persons in the Baltimore Standard Metropolitan Statistical Area revealed rates of medicine use and characteristics of users. In the 2 days before interview, 56% of the study population used one or more medicines. Users of prescribed medicine (33%) averaged 1.8 different kinds, and users of nonprescribed medicine (36%) averaged 1.4 kinds. Among users of prescribed medicine, 39% were also self-medicating. Pain relievers, vitamins, and cough and cold medicines were the most frequently used types. Two-thirds of physician visits were associated with an injection, immunization, medicine, or prescription. Rates of use for both prescribed and nonprescribed medicine were higher in females and varied with age, with nonprescribed varying less than prescribed. Nonwhites were less likely than whites to use either prescribed or nonprescribed medicines in all social status categories. Use of prescribed medicine increased with the increasing severity of acute and chronic illness, but use of nonprescribed medicine varied little with morbidity. Use of prescribed or nonprescribed medicine did not vary with economic class. Differences in use by age, sex, and race could not be accounted for by differences in morbidity, physician visits, or use of oral contraceptives.Data derived from a 1968–69 household survey of 3,481 persons in the Baltimore Standard Metropolitan Statistical Area revealed rates of medicine use and characteristics of users. In the 2 days before interview, 56% of the study population used one or more medicines. Users of prescribed medicine (33%) averaged 1.8 different kinds, and users of nonprescribed medicine (36%) averaged 1.4 kinds. Among users of prescribed medicine, 39% were also self-medicating. Pain relievers, vitamins, and cough and cold medicines were the most frequently used types. Two-thirds of physician visits were associated with an injection, immunization, medicine, or prescription. Rates of use for both prescribed and nonprescribed medicine were higher in females and varied with age, with nonprescribed varying less than prescribed. Nonwhites were less likely than whites to use either prescribed or nonprescribed medicines in all social status categories. Use of prescribed medicine increased with the increasing severity of acute and chronic illness, but use of nonprescribed medicine varied little with morbidity. Use of prescribed or nonprescribed medicine did not vary with economic class. Differences in use by age, sex, and race could not be accounted for by differences in morbidity, physician visits, or use of oral contraceptives.

Asthma self-management: the perspective of children

This qualitative study explored the knowledge, perceptions, and autonomy of 7- and 12-year-old children relative to the management of their asthma. A total of 32 children with moderate to severe asthma were interviewed using an open-ended drawing interview and a semi-structured interview. The triangulation of results from these two methods revealed developmental differences. Younger children identified medicines by shape, color, or lay terms, relied on adults to manage their asthma, and did not recognize warning symptoms of an attack. Older children mastered biomedical terminology and used medicines independently, although they sometimes asked for the assistance of an adult. All children perceived benefits and non-monetary costs of asthma medicines. However, they lacked understanding of the categories and role of asthma medicines. This study suggests that long-term control and quick-relief metered dose inhalers should be identifiable by consistent color-coding, and that professionals should tailor asthma education and information to childrens stages of cognitive development.

The Use of Medicines: Historical Trends and International Comparisons

An historical review of the development of current levels of medicine consumption is presented with a literature review of cross-national and limited surveys and national statistics on rates of medicine use. Medicine use has increased worldwide at rates exceeding increases in national incomes in many countries. Variations in estimates of medicine use are documented by cross-national data on expenditure and prescription rates adjusted to increase comparability. Differences in levels of use appear greater than can be accounted for by methodologic problems of comparison. That differences are great is supported by results of the World Health Organization International Collaborative Study of Medical Care Utilization (WHO/ICS-MCU) which indicate that age-sex standardized medicine use rates developed from a household survey in 12 areas of seven countries show several-fold differences in rates of prescribed and nonprescribed medicine use. Differences in these rates are not explained by area levels of morbidity or variations in physician visiting or prescribing patterns. Areas tend to be high or low in rates of use of both prescribed and nonprescribed drugs. Problems in the use of data for international comparison of medicine use are discussed.

Healthy children's perceptions of medicines: A review

BACKGROUND Chronically ill childrens perceptions of medicines have been widely studied, but healthy childrens less often. However, information on healthy childrens beliefs and attitudes about medicine use is needed to be able to target health education messages about medicines appropriately. OBJECTIVES A literature review was performed to determine schoolchildrens attitudes, beliefs, and knowledge about medicines; autonomy in using medicines; expectations of using medicines; and questions about medicines, so as to guide the development of a medicine education curriculum and to inform health care professionals who communicate with children. METHODS This study was a review of literature from 17 countries. RESULTS The review indicated that children of school age tend to view medicines cautiously. Although age is a factor, children have very limited ideas about how medicines work and issues around medicine efficacy are confusing to them. Even young children recognize that medicines may have harmful effects and, children of all ages and cultures studied want to learn more about medicines. Autonomy in medicine use is surprisingly high and disturbing given that knowledge of medicines is poor. CONCLUSIONS Primary conclusions drawn are (1) children of the same age in different cultures appear similar in their attitudes, beliefs, behaviors, and desires to learn about medicines; (2) children lack information about medicines, especially in view of their levels of autonomy; and (3) health educators and health care professionals should educate children about rational medicine use, at appropriate cognitive development levels, before the children become independent medicine users.

Development and evaluation of an educational interactive CD-ROM for teens with cancer†

Cancer is the number one disease killer of children and adolescents in North America. For adolescents, this diagnosis comes at a particularly vulnerable stage. Educating adolescents with cancer from diagnosis through treatment teaches and empowers them. Increasing evidence shows that these adolescents want more information. Few educational tools exist for young cancer patients; none are interactive; therefore, a CD‐ROM was developed to meet this need.

Families versus peers: Developmental influences on drug use from grade 4–5 to grade 7–8

Abstract This study examined the relative influence of family and peers on abusable substance use, and whether relative influences on problem behaviors are behavior specific as children move from pre- to early adolescence. In 1988–1989, urban public school students in Grades 4–5 completed a substance abuse survey. The survey was repeated in each of the following 3 years into Grades 7–8; 1,802 students, of whom 91% were black, participated on all four occasions. Data were analyzed using structural equation modeling with cross-validation. Perceived family use was a stronger influence on abusable substance use relative to perceived peer use when the students were younger, whereas perceived peer use had more influence when they were older. Prior use predicted perceived family as well as perceived peer use. Varying direct and indirect pathways predicted licit drug use, illicit drug use, and other problem behaviors in Grades 7 and 8, although perceived peer use predicted all three. The results suggest that the relative shift from the influence of families to peers observed among adolescents is consistent among younger urban children. Drug use predisposes children toward greater perceptions of drug use among families and peers, and relative influences on problem behaviors may vary with the specific behavior. Interventions should begin in elementary school as the influence on students is shifting from family toward peers.