Parents and adolescents with asthma express disparate preferences for parameters of asthma control: A best-worst scaling choice experiment

Background:Despite the availability of asthma guidelines, achieving control continues to be challenging for children, parents and health providers. Research has shown that adult asthma patients and parents have unique perceptions of asthma control. Since children depend on parents/caregivers to serve as gatekeepers for their access to health services and use of medications, parental preferences play an important role in a child’s asthma control. None of the clinical practice guidelines considers preferences with regard to actual parameters of asthma control, which may affect use of health services and adherence to disease management plans. The study objective was to measure and compare the preferences of parents and adolescents with asthma with regard to asthma control parameters using best worst scaling (BWS).

Methods:Fifty-two parents of children with asthma and 44 adolescents with asthma participated in a BWS study to quantify preferences regarding night-time symptoms, wheezing/chest tightening, changes in asthma medications, emergency visits and physical activity limitations.  Using an orthogonal main effects plan design, a questionnaire with 18 choice tasks was created. To avert respondent fatigue, this questionnaire was divided into two blocks or versions, each with nine choice tasks. Each task contained the same five attributes, with levels that varied across tasks. Each task asked respondents to choose the most and least preferred items. Conditional logit regression was used to determine each group’s utility for each level of each asthma control parameter.

Results:Parents displayed the strongest positive preference for the absence of night-time symptoms (β = 2.09, p < 0.00001) and the strongest negative preference for 10 emergency room visits per year (β = -2.15, p < 0.00001). Adolescents displayed the strongest positive preference for the absence of physical activity limitations (β = 2.17, p < 0.00001) and the strongest negative preference for ten physical activity limitations per month (β = -1.97). Both groups were least concerned with changes to medications.

Conclusion: Parents and adolescents placed different weights on the importance of asthma control parameters and each group displayed unique preferences. Because parents can observe night-time symptoms and are also affected by it, their strong preference for preventing night-time symptoms reflects their perception of what constitutes poor asthma control. In contrast, adolescents with asthma expressed the strongest utility for avoiding physical activity limitations that may disrupt their peer relations and affect their perception of their own health. Understanding the relative importance placed on each parameter by parents and adolescents and the basis for divergence in preferences is essential for an understanding the choices parents make on behalf of their children to improve their asthma control. Explicitly acknowledging the differences in preferences between parents and adolescents would also enhance patient-parent-provider communication and improve the design of patient-focused disease management plans.