TABLE 1.
Questions on the Child/Adolescent and the Parent/Caregiver Questionnaire
| People may miss their medications for various reasons. In the past month, how often have you/your child missed taking medication because of the following reasons? Circle 1 number for each question. Response options are: Never or Rarely, Sometimes, Often, Mostly or Always | |||
|---|---|---|---|
| Type | Barrier | Question to Child | Question to Caregiver |
| Logistical | Child could not get meds | Couldn’t get medication (drugstore doesn’t have supply) | Couldn’t get medication (drugstore doesn’t have supply) |
| Did not refill | Didn’t refill; ran out | Didn’t refill; ran out | |
| Forgot | Forgot | Forgot | |
| Schedule interfered | Scheduling interferes with lifestyle (meals, school, sleep) | Scheduling interferes with child’s lifestyle (meals, school, sleep) | |
| Multiple caregivers | Multiple caregivers | Multiple caregivers | |
| Child away | Were away from home | Child was away from home | |
| Busy with other things | Were busy with other things | We were busy with other things | |
| Change in daily routine | Had a change in daily routine | We had a change in daily routine | |
| Slept through dose time | Fell asleep or slept through dose time | Caregiver fell asleep or slept through dose time | |
| Regimen | Cannot keep down | Taste, can’t get it down, or keep it down (pill or liquid) | Taste, can’t get it down, or keep it down (pill or liquid) |
| Too much medication | Had too many pills to take | Child had too much medication to take | |
| Avoid side effects | Wanted to avoid side effects | We wanted to avoid side effects | |
| Toxicity | Felt like medication was toxic or harmful | Caregiver felt like medication was toxic or harmful | |
| Problems taking as directed | Had problem taking pills as directed, for example, with meals or on an empty stomach | Child had problem taking pills as directed, for example, with meals or on an empty stomach | |
| Child | Child refused | Just didn’t want to | Child refuses |
| Child felt sick | Felt sick or ill | Child felt sick or ill | |
| Child felt good | Felt good | Child felt good | |
| Disclosure | Child concerned that others notice medications | Did not want others to notice medication | Child did not want others to notice medication |
| Emotional | Felt depressed | Felt depressed or overwhelmed | Caregiver felt depressed or overwhelmed |