• Maureen George, Kathleen Birck, David J Hufford, Loretta Sweet Jemmott, and Terri E Weaver.
• Johns Hopkins University School of Nursing, Baltimore, MD, USA. mgeorg 16@son.jhmi.edu
• J Gen Intern Med. 2006 Dec 1; 21 (12): 131713241317-24.

BackgroundThe gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities,alternative beliefs and behaviors need to be identified.ObjectiveTo identify causal models of asthma and the context of conventional prescription versus complementary and alternative medicine(CAM) use in low-income African-American (AA) adults with severe asthma.DesignQualitative analysis of 28 in-depth interviews.ParticipantsTwenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident.ApproachTranscripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach.ResultsSixty-four percent of participants held biologically correct causal models of asthma although 100% reported the use of at least 1 CAM for asthma. Biologically based therapies, humoral balance, and prayer were the most popular CAM. While most subjects trusted prescription asthma medicine, there was a preference for integration of CAM with conventional asthma treatment. Complementary and alternative medicine was considered natural, effective, and potentially curative. Sixty-three percent of participants reported non adherence to conventional therapies in the 2 weeks before the research interview. Neither CAM nor nonmedical causal models altered most individuals(93%) willingness to use prescription medication. Three possibly dangerous CAM were identified.ConclusionsClinicians should be aware of patient-generated causal models of asthma and use of CAM in this population. Discussing patients' desire for an integrated approach to asthma management and involving social networks are 2 strategies that may enhance patient provider partnerships and treatment fidelity.

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