Krupa Sekhar ’25 spent this summer researching adherence to asthma inhaler medication in India under the Laidlaw Research and Scholarship Program, merging her interests in health equity, medicine and social justice.
Since its inauguration in 2021, the Laidlaw Program has hosted two cohorts. The program is divided across two summers and provides student leaders with a six-week funded research project, leadership development training, an international leadership-in-action program and network of global scholars.
During her six weeks in Bangalore, India, Sekhar conducted observational and oral surveys on about 80 parents of pediatric asthma patients under the guidance of pulmonologist Dr. Bharath Reddy at the Shishuka Children’s Specialty Hospital. This hospital was chosen for its broad representation of patient socioeconomic status.
The survey, sometimes translated into the city’s official language Kannada, included questions about parents’ perceived and actual understanding of asthma.
Parents were asked about common asthma misconceptions, such as the addictiveness and danger of the inhaler steroid treatment, to determine their actual understanding of asthma.
Parents were also asked to mark their level of agreement on statements such as on how COVID-19 affected their desire to comply with the treatment, resources that helped them understand the treatment and how much they trusted their doctor. Answers to these questions helped them understand how these external factors may be correlated with asthma treatment perceptions.
The surveys were analyzed using a logistic regression on R software. The results showed that there is no significant correlation between perceived and actual understanding of asthma, meaning some parents believed they had a strong understanding of the disease but also believed many misconceptions to be true.
However, it was found that a good perceived asthma understanding was correlated with improved asthma adherence.
Sekhar was curious about why parents had a good perceived understanding of asthma. Analysis of the survey results revealed a correlation between the doctor-patient-parent relationship and perceived asthma understanding, indicating that doctors must foster trust with the patient and parent in order to improve asthma treatment adherence.
“It’s kind of a linear relationship where if you build a good relationship with the child’s parents and the child, as a doctor you explain asthma while you make them feel seen and heard, then they will have a good perceived understanding of asthma, which then makes them want to adhere with the child’s treatment more,” Sekhar said.
Unlike the American medical system, Bangalore-based patients spend about five minutes with their physician, Sekhar explains, so patient-centered care is less of a priority.
“There isn’t much emphasis on fostering relationships and building trust because [they] can’t really do that when [they] have so many patients to see,” Sekhar said.
Another barrier to fostering meaningful relationships with doctors, patients and their parents are negative reviews about the doctor in the community, which place patients at an initial position of doubt.
However, Sekhar also recognized distinctions between American and Indian hospital systems.
“Even if you can’t afford much [in India], you can go to government hospitals and get really good care,” Sekhar said. “The US healthcare system, where everyone has to deal with insurance…there is Medicaid, but it doesn’t cover nearly enough for families who need it.”
Sekhar hopes to learn how to use her research with Laidlaw and Dr. Reddy to start improving asthma treatment adherence.
Based on past relevant literature, she explained that collaborative and conversational decision-making can be effective.
“[Doctors are working on] making the parent feel like their input is valued, and that they’re involved in their child’s health care decisions,” Sekhar said.
Sekhar will present her project, along with other Laidlaw Scholars, at the Laidlaw Symposium on Sept. 28 in the Physical Sciences Building.