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J Pediatr Psychol. 2003 Sep;28(6):383-92.

The Illness Management Survey: identifying adolescents' perceptions of barriers to adherence.

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Department of Psychology, The Children's Hospital of Philadelphia, PA 19104, USA.



To develop a self-report measure of barriers to adherence and to evaluate its reliability and validity in a sample of adolescents with asthma.


The Illness Management Survey (IMS) was developed through item generation, expert panel review, and focus group administration. Adolescents with asthma (N = 152) completed the measure. Participants reported on perceived drawbacks to medication, risk-taking behavior, and social desirability tendencies. Providers rated adolescents' illness severity and adherence. Reliability and validity of the IMS were assessed, and factor structure was examined.


The 27-item IMS shows high internal consistency (alpha =.87). Scores correlate with perceived medication drawbacks, risk taking, and self- and provider reports of adherence. Principal-components analysis indicates five domains of barriers, accounting for 52.4% of the variance: disease/regimen issues, cognitive difficulties, lack of social support/lack of self-efficacy, denial/distrust, and peer/family issues.


Preliminary data indicate that the IMS reliably and validly assesses perceived barriers to adherence within this sample of adolescents with asthma. It shows promise as a tool for identifying subgroups of nonadherent adolescents.

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