Adolescent Asthma Medication Adherence: Role of Motivation, Perceived Competence

Asthma medications on wood surface.
Asthma medications on wood surface.
A clinical trial of urban adolescents with poorly controlled asthma explored the links between autonomous motivation, perceived competence, and medication adherence.

A clinical trial of urban adolescents with asthma found those with higher treatment adherence reported higher levels of autonomous motivation and self-perceived competence than adolescents with low levels of treatment adherence. This was among study findings reported in the Journal of Pediatric Health Care.

Self-determination theory (SDT) suggests that being autonomously motivated by one’s own best interests (rather than being controlled by external pressures) positively affects motivation, and that those with perceived competence are more likely to take effective action. However, there is currently scarce research on how these factors may affect adherence to an asthma treatment regimen. Investigators therefore sought to explore how autonomous motivation (AM) and perceived competence (PC) in adolescents are associated with self-reported asthma medication adherence.

The investigators conducted a retrospective, cross-sectional study using data from the School-Based Asthma Care for Teens study ( Identifier: NCT02206061), which included 260 adolescents 12 to 16 years of age in Rochester, New York, with poorly controlled asthma (59% male; 58% Black, 29% Hispanic; mean age 13.4 years; 85% with public insurance; 50% living in a home with 1 smoker). About a quarter of patients and a third of caregivers self-reported symptoms of depression. Study participants were all taking daily preventive medication at baseline for persistent asthma.

The analysis found that adolescents who expected to miss at least 1 medication dose in the next 2 weeks had reduced AM and PC with respect to medication adherence, compared with those who did not expect to miss any doses, who had higher AM and PC. “Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC,” the researchers explained, noting that even in regression analysis with control variables, these findings still remained significant.

“Our findings provide validation that SDT variables are relevant for understanding asthma medication adherence for a sample of historically marginalized adolescents with persistent symptoms,” said researchers. “Clinicians’ efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group,” they noted.

Study limitations include the lack of sample diversity and response bias stemming from self-reporting.


Blaakman SW, Fagnano M, Borrelli B, Riekert KA, Halterman JS. Self-determination theory and preventive medication adherence: Motivational considerations to support historically marginalized adolescents with asthma. J Pediatr Health Care. Published online July 1, 2022. doi:10.1016/j.pedhc.2022.06.001