Beliefs About Asthma and Complementary and Alternative Medicine in Low-Income Inner-City African-American Adults


  • No conflicts of interest to declare.

Address correspondence and requests for reprints to Dr. George: Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205 (e-mail:


BACKGROUND: The 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.

OBJECTIVE: To 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.

DESIGN: Qualitative analysis of 28 in-depth interviews.

PARTICIPANTS: Twenty-six women and 2 men, aged 21 to 48, who self-identified as being AA, low-income, and an inner-city resident.

APPROACH: Transcripts of semi-structured in-depth qualitative interviews were inductively analyzed using the constant comparison approach.

RESULTS: Sixty-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 nonadherence 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.

CONCLUSIONS: Clinicians 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.