72.[18] Problems with medications were assessed on the child interview and caregiver questionnaire immediately after the medical visit and then 1 month later at a home visit. Children were asked if they had had a problem in using asthma medications in each of the following areas: side effects, hard to remember Anti-cancer Compound Library screening when to take, hard to use medications at school, not sure they are using

their inhalers correctly, hard to understand the directions on the medications, hard to read the print on the package and other problems/concerns. Response options included: none, a little, or a lot. Caregivers were asked if they perceived their child had a problem in using asthma medications in each of the following areas: child has side effects, hard to remember when the child is supposed to take, hard to pay for medications, not sure child is using his/her inhaler correctly, hard to get the child’s refills

on time, hard to understand the directions on the medications, hard to read the print on the package and other problems/concerns. All of the medical visit audiotapes were transcribed verbatim, and a detailed coding tool was developed to assess provider, child and caregiver communication about asthma. This tool was refined and tested over a 1-year period. The categories used in the coding tool for communication about asthma medications were adapted from the categories used in prior studies of provider–patient communication about medications.[19-22] The transcripts were reviewed by two research assistants who met twice a month with the investigators to develop and refine the coding see more rules until saturation of themes was achieved. Two research assistants coded 20 of the same transcripts throughout the study period to assess inter-coder reliability. Using the coding tool for transcribed medical visits, coders recorded the following: whether children asked one or more medication questions, whether caregivers asked one or more medication

questions, the number of questions providers asked about control medications, whether provider ID-8 asked (yes/no) for child input into the asthma treatment regimen and whether the provider asked (yes/no) for caregiver input into the asthma treatment regimen. Inter-rater reliability ranged from 0.88 to 1.0 for the communication variables. Areas of overlap between the problems with medications measure and actual medication questions that children and caregivers asked were: asthma medication device technique, frequency of use/timing of medication use, quantity/supply of medication (caregivers only), side effects, and school use (children only). Each of the child and caregiver reported problem areas were recoded into dichotomous variables (no or a little problem versus a lot of a problem) and a summary score was created and then dichotomized to express whether each child and caregiver reported one or more asthma medication problems/concerns.