Focus groups were conducted with children with asthma to generate descriptive data regarding asthma adherence. Transcripts of focus groups were analyzed using qualitative methods. Data collection occurred at an outpatient department of a university-affiliated hospital and at a summer camp for children with asthma. Thirty-six children with asthma ranging in age from 9 years, 1 month to 15 years, 3 months (M age = 11 years, 10 months) participated. Participants provided qualitative descriptions of asthma experiences, including consequences, adherence barriers, and strategies to improve adherence. Researchers also elicited participants' feedback regarding theoretically derived strategies to improve adherence. Children's perceived consequences of asthma included feeling ill, limitations on peer interactions, and medication annoyances. Frequently endorsed barriers to medication adherence were lack of motivation, difficulties remembering, and social barriers. Child-generated strategies to improve adherence included reminders, social strategies, and enhancing accessibility. When children were asked about specific strategies provided by the researchers, motivational strategies (i.e., use of reward as positive reinforcement) were the most highly endorsed. Findings revealed two paradoxes: 1) although children complained that parental reminders are annoying, they also reported that parental prompts help to improve their adherence, and 2) the use of rewards to reinforce adherence was a highly endorsed strategy when presented to children; however, children did not generate this type of strategy on their own.

Asthma is increasing dramatically among poor, inner-city children. Fourteen children with, and twelve without, asthma were interviewed and observed to examine how children with asthma understand their illness and how the asthma experience shapes their sense of place. Quantitative data showed no difference in objective preferences for particular places, but qualitative analysis showed important differences. We identified eight place-related themes, and on seven there were clear differences between children with and without asthma--offering freedom, being aesthetically pleasing, being comfortable, nature of social contact, being isolating, being familiar and being safe. Children experienced asthma as an interruption in daily life that influences time spent outside, being active and being with friends. Children with asthma are more sensitive to places that are 'dirty' or contain asthma triggers, are less likely to explore new or people-free places and emphasize family interactions, while children without asthma emphasize friendships and are sensitive to neighborhood violence.

BackgroundIn an effort to identify previously unrecognized aspects of editorial decision-making, we explored the words and phrases that one group of editors used during their meetings.MethodsWe performed an observational study of discussions at manuscript meetings at JAMA, a major US general medical journal. One of us (KD) attended 12 editorial meetings in 2003 as a visitor and took notes recording phrases from discussion surrounding 102 manuscripts. In addition, editors attending the meetings completed a form for each manuscript considered, listing the reasons they were inclined to proceed to the next step in publication and reasons they were not (DR attended 4/12 meetings). We entered the spoken and written phrases into NVivo 2.0. We then developed a schema for classifying the editors' phrases, using an iterative approach.ResultsOur classification schema has three main themes: science, journalism, and writing. We considered 2,463 phrases, of which 87 related mainly to the manuscript topic and were not classified (total 2,376 classified). Phrases related to science predominated (1,274 or 54%). The editors, most of whom were physicians, also placed major weight on goals important to JAMA's mission (journalism goals) such as importance to medicine, strategic emphasis for the journal, interest to the readership, and results (729 or 31% of phrases). About 16% (n = 373) of the phrases used related to writing issues, such as clarity and responses to the referees' comments.ConclusionClassification of editorial discourse provides insight into editorial decision making and concepts that need exploration in future studies.

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