Table 2.

Adolescent-endorsed intrapersonal and external adherence barriers to inhaled corticosteroid adherence.

Interview themes		Participants who endorsed, n (%)		Number of times a barrier was mentioned		Description of barrier		Sample quotes
Intrapersonal barriers
	Forgetting		19 (95)		71		The teen describes forgetting to take their medicine.		“I definitely forget to take it at least 2-3 times a week.”
	Time management/busyness		16 (80)		35		The teen does not take medicine due to busyness or other activities (eg, going to school or work).		“Having to take medicine on a daily basis is a bit difficult for me because I have a busy schedule. I’ll be more focused on something and end up forgetting.”
	Sleep/fatigue		12 (60)		21		The teen does not take medicine due to abnormal sleep patterns, difficulty waking up in the morning, going to sleep late, or being fatigued.		“If I’m really tired or I had a long day or I got back from a soccer game, usually if it’s a late night, I’ll forget to take it because I’ll be so tired.”
	Mood		8 (40)		11		The teen’s mood (eg, depression, anxiety, sadness, frustration, anger) is a barrier that prevents them from taking medicine.		“If I’m kind of like in a ‘eh’ mood, I won’t take them, but if I’m happy, I’ll take them. Yeah, it definitely depends on my mood.”
	Not wanting to take meds		6 (30)		12		The teen mentions not wanting to, deciding not to, or not feeling like taking meds without giving a reason that would better fit in another category.		“Besides forgetfulness, sometimes I just don’t feel like taking it.”
	Stress		4 (20)		5		The teen describes stress as a barrier to taking medicine.		“I guess sometimes if I'm super tired or stressed, then I won't really focus on [taking meds].”
	Embarrassment		3 (15)		5		The teen describes embarrassment as a barrier to taking medicine (eg, being embarrassed to take medicine in front of friends).		“It’s kind of embarrassing to pull out an inhaler right before games… It’s just not being embarrassed to take it in front of other people I guess.”
	Laziness		3 (15)		3		The teen mentions laziness as a barrier to taking medicine.		“It’s just my own, I don’t know, laziness I guess that makes it harder to take my medication.”
	Not seeing meds as necessary		3 (15)		3		The teen does not see medicine as necessary (eg, they believe taking medicine does not help them, or they believe they do not need medicine).		“The controller one, it doesn't really do that much to you. It doesn't have an effect if you stop taking it or not. That's why it doesn't affect me that I didn't take it that much.”
	Feeling sick		2 (10)		3		The teen does not take medicine due to feeling sick (eg, nauseous, having a headache).		“I could be extremely nauseous one day and not take it for the reason that I would throw up if I did.”
	Misplacement		2 (10)		3		The teen does not take medicine because they or someone else lost their medicine (inhaler or spacer).		“One time [my dog] put my inhaler somewhere that I couldn't find it.”
	Feeling different		1 (5)		1		The teen does not take medicine because it reminds them that their asthma diagnosis makes them different from their peers.		“It’s depressing when you can’t run with the other kids in gym or you can’t take dance classes or you have to sit out of something or just do your own thing… You feel like you’re not normal.”
	Lack of organization		1 (5)		1		The teen mentions “not being organized” as a barrier to taking medicine.		“Not being organized [makes it harder to take meds], or like having so much stuff to do.”
External barriers
	Changes in routine		12 (60)		24		The teen describes changes in their routine (eg, being away from home) as a barrier to taking medicine.		“Running late [makes it harder to take meds], and when it’s not the weekdays, because in the morning I just have my routine, but on the weekends it varies.”
	Running out of meds		11 (55)		11		The teen runs out of medicine because they forget to fill their prescription or they have insurance difficulties.		“I won’t check how many I have left, how many pills or QVAR puffs or something, I’ll run low, so I have to take one puff instead of two. Or I’ll run out before we can order it and get it back in.”
	Other things get in the way		10 (50)		21		The teen does not take medicine due to interference from various activities (eg, watching TV, caring for dog). These activities are often unspecified (eg, “doing other stuff”).		“Most of the time, it's hard for me to remember because I'll be thinking about other things, too, so it isn't really right there in the top of my head.”
	Friends, peers, or other people		7 (35)		10		The teen does not take medicine due to influence from other people, including peers (eg, hanging out with friends, feeling victimized by peers) and siblings.		“It could be times where I hang out with friends and stuff that could get in the way [of taking meds], because I'm going to forget about everything.”
	Changes in medication		1 (5)		1		The teen does not take medicine because they are in the process of changing their medicine, inhaler, or dosage.		“There was [a time] when I was in-between medicine on the one that I take every day, because they were changing the style of the inhaler and the doses, and I didn't take it for a little while.”
	Cost of medicine		1 (5)		1		The teen has difficulty obtaining medicine because it is too expensive.		“[My doctor] wants to put me on a new inhaler, but the insurance doesn't want to cover it, so my pharmacy has to talk to the doctor, and they're trying to figure that out, so I'm not able to use what the doctor wants me to right now.”