CLINICAL PHARMACY RESEARCH REPORT Association between parental expectation, parenting stress, and parents' adherence intention to medication therapy for children with asthma Yasser Almogbel M.S., Ph.D. 1 | Qingqing Xu M.S. 2 | Shubhada Sansgiry Ph.D. 3,4,5 | Ekere J. Essien M.D., DrPH 2 | Marc L. Fleming Ph.D., MPH 6 | Susan M. Abughosh Ph.D. 2 | Sujit S. Sansgiry Ph.D. 2 1 College of Pharmacy, Qassim University, Buraydah, Qassim, Saudi Arabia 2 Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas 3 Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas 4 Veterans Affairs South Central Mental Illness Research Education and Clinical Center (MIRECC), Houston, Texas 5 Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas 6 Department of Pharmacotherapy, College of Pharmacy, University of North Texas (UNT) System. UNT Health Science Center, Fort Worth, Texas Correspondence Sujit S. Sansgiry, Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Health Building 2, 4849 Calhoun Road, Room 4050, Houston, TX 77204-5047. Email: sansgiry@central.uh.edu Present address Yasser Almogbel, Assistant Professor and Vice Dean for Administrative Affairs, College of Pharmacy, Qassim University, Buraydah, Qassim, Saudi Arabia. Introduction: Taking care of children with asthma, especially those who cannot take their medications according to treatment regimens, can be burdensome for parents and lead to additional parenting stress. Understanding the care process of parents with asthmatic children and helping parents better manage their children's asthma medication use is critical to health care providers. This study aimed to explore how parental factors, namely parental expectation, parental perceived performance, parental confirmation, parental satisfaction, and parenting stress impact parents' intention to adhere to asthma medications (PIAAM) for their children. Methods: A cross-sectional online Qualtrics survey was administered to parents of children aged between 2 and 12 who were visiting participating asthma/pediatric clinics. The survey assessed the above-mentioned factors adapted from the expecta- tion confirmation theory (ECT), along with parents' health literacy, number of asthma medications used by the children, and socio-demographic characteristics of both par- ents and children. Spearman's correlation, multiple regression, and path analyses were conducted to determine the relationship between model variables with parents' and children's characteristics. Results: The findings from a total of 261 surveys indicated that PIAAM was signifi- cantly correlated with all parental factors (P < 0.05). Path analyses indicated an indi- rect effect of parenting stress on PIAAM. Multiple regression and path analyses both suggested that parental expectation (β = 0.369, P < 0.05) and number of asthma med- ications (β = 0.659, P < 0.05) were significant predictors for PIAAM after controlling for other covariates. Conclusions: Reducing parenting stress can enhance parental expectation of asthma medications, and hence improve PIAAM. Understanding parents' perspectives may enable health care providers to provide better care for children with asthma. KEYWORDS asthma, expectations, medication adherence, parenting, satisfaction Received: 12 December 2018 Revised and accepted: 11 March 2019 DOI: 10.1002/jac5.1112 J Am Coll Clin Pharm. 2019;**(**):1–8. wileyonlinelibrary.com/journal/jac5 © 2019 Pharmacotherapy Publications, Inc. 1