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African American emerging adults (age 18–29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.

Background Understanding the barriers and facilitators of implementation completion is critical to determining why some implementation efforts fail and some succeed. Such studies provide the foundation for developing further strategies to support implementation completion when scaling up evidence-based practices (EBPs) such as Motivational Interviewing. Method This mixed-methods study utilized the Exploration, Preparation, Implementation, and Sustainment framework in an iterative analytic design to compare adolescent HIV clinics that demonstrated either high or low implementation completion in the context of a hybrid Type III trial of tailored motivational interviewing. Ten clinics were assigned to one of three completion categories (high, medium, and low) based on percentage of staff who adhered to three components of implementation strategies. Comparative analysis of staff qualitative interviews compared and contrasted the three high-completion clinics with the three low-completion clinics. Results Results suggested several factors that distinguished high-completion clinics compared to low-completion clinics including optimism, problem-solving barriers, leadership, and staff stress and turnover. Conclusions Implementation strategies targeting these factors can be added to EBP implementation packages to improve implementation success.

This study included African Americans with asthma in emerging adulthood, a developmental period largely neglected in the research literature but known to be a time of great risk asthma morbidity and mortality. We conducted thematic analysis of semi-structured interviews ( N = 19) to explore barriers to adherence in the context of the transition into adulthood. Key themes for non-adherence emerged after careful follow-up prompting by the interviewer: forgetting to take medications, deciding not to take medications as prescribed, and systemic barriers. Clinicians and researchers interested in improving adherence should carefully assess barriers to adherence when working with this population. Effective adherence interventions should target both intentional and unintentional reasons for non-adherence behavior and take into account the unique developmental needs of emerging adults.