Adherence to Medication in Adults with Cystic Fibrosis: An Investigation Using Objective Adherence Data and the Theoretical Domains Framework

Overview

Journal Br J Health Psychol

Specialty Psychology

Date 2019 Mar 3

PMID 30825258

Citations 20

Authors

Madelynne A Arden

Sarah Drabble

Alicia OCathain

Marlene Hutchings

Martin Wildman

Affiliations

Soon will be listed here.

Abstract

Objectives: Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence.

Design: Data-prompted interviews using the TDF.

Methods: Eighteen semi-structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored.

Results: Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision-making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions.

Conclusions: This study is the first to use objectively measured adherence data in a data-prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem-solving may be particularly useful for adults with CF. Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self-reported adherence and objectively measured adherence. What this study adds A data-prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one-size fits all intervention for adherence to medication in cystic fibrosis.

Citing Articles

Improving health literacy of antibiotic use in people with cystic fibrosis (CF)-comparison of the readability of patient information leaflets (PILs) from the EU, USA and UK of 23 CF-related antibiotics used in the treatment of CF respiratory....

Tang K, Millar B, Moore J JAC Antimicrob Resist. 2023; 5(6):dlad129.

PMID: 38046567 PMC: 10691746. DOI: 10.1093/jacamr/dlad129.

Nebuliser systems for drug delivery in cystic fibrosis.

Stanford G, Morrison L, Brown C Cochrane Database Syst Rev. 2023; 11:CD007639.

PMID: 37942828 PMC: 10633867. DOI: 10.1002/14651858.CD007639.pub3.

Medication adherence in youths with CKD: habits for success.

Eaton C, Comer M, Pruette C, Riekert K Pediatr Nephrol. 2023; 38(11):3791-3802.

PMID: 37306720 PMC: 11587169. DOI: 10.1007/s00467-023-05976-0.

Digital technology for early identification of exacerbations in people with cystic fibrosis.

Wong C, Smith S, Kansra S Cochrane Database Syst Rev. 2023; 4:CD014606.

PMID: 37057835 PMC: 10103544. DOI: 10.1002/14651858.CD014606.pub2.

Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis.

Dawson S, Girling C, Cowap L, Clark-Carter D Cochrane Database Syst Rev. 2023; 3:CD013766.

PMID: 36989170 PMC: 10054300. DOI: 10.1002/14651858.CD013766.pub2.

References

Kahwati L, Viswanathan M, Golin C, Kane H, Lewis M, Jacobs S . Identifying configurations of behavior change techniques in effective medication adherence interventions: a qualitative comparative analysis. Syst Rev. 2016; 5:83. PMC: 4875709. DOI: 10.1186/s13643-016-0255-z. View

Pakhale S, Baron J, Armstrong M, Tasca G, Gaudet E, Aaron S . Lost in translation? How adults living with Cystic Fibrosis understand treatment recommendations from their healthcare providers, and the impact on adherence to therapy. Patient Educ Couns. 2016; 99(8):1319-24. DOI: 10.1016/j.pec.2016.03.023. View

Hogan A, Bonney M, Brien J, Karamy R, Aslani P . Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study. Int J Clin Pharm. 2014; 37(1):86-93. DOI: 10.1007/s11096-014-0043-6. View

Campbell J, Eyal N, Musiimenta A, Haberer J . Ethical Questions in Medical Electronic Adherence Monitoring. J Gen Intern Med. 2015; 31(3):338-42. PMC: 4762813. DOI: 10.1007/s11606-015-3502-4. View

de Bruin M, Oberje E, Viechtbauer W, Nobel H, Hiligsmann M, Van Nieuwkoop C . Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV: a pragmatic, multicentre, open-label, randomised clinical trial. Lancet Infect Dis. 2017; 17(6):595-604. DOI: 10.1016/S1473-3099(16)30534-5. View

Modi A, Quittner A . Barriers to treatment adherence for children with cystic fibrosis and asthma: what gets in the way?. J Pediatr Psychol. 2006; 31(8):846-58. DOI: 10.1093/jpepsy/jsj096. View

Sawicki G, Sellers D, Robinson W . High treatment burden in adults with cystic fibrosis: challenges to disease self-management. J Cyst Fibros. 2008; 8(2):91-6. PMC: 2680350. DOI: 10.1016/j.jcf.2008.09.007. View

Easthall C, Barnett N . Using Theory to Explore the Determinants of Medication Adherence; Moving Away from a One-Size-Fits-All Approach. Pharmacy (Basel). 2017; 5(3). PMC: 5622362. DOI: 10.3390/pharmacy5030050. View

George M, Rand-Giovannetti D, Eakin M, Borrelli B, Zettler M, Riekert K . Perceptions of barriers and facilitators: self-management decisions by older adolescents and adults with CF. J Cyst Fibros. 2010; 9(6):425-32. PMC: 3049301. DOI: 10.1016/j.jcf.2010.08.016. View

10.

Zullig L, Shaw R, Crowley M, Lindquist J, Grambow S, Peterson E . Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circ Cardiovasc Qual Outcomes. 2013; 6(6):619-25. DOI: 10.1161/CIRCOUTCOMES.113.000435. View

11.

Michie S, van Stralen M, West R . The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6:42. PMC: 3096582. DOI: 10.1186/1748-5908-6-42. View

12.

Foster C, Eiser C, Oades P, Sheldon C, Tripp J, Goldman P . Treatment demands and differential treatment of patients with cystic fibrosis and their siblings: patient, parent and sibling accounts. Child Care Health Dev. 2001; 27(4):349-64. DOI: 10.1046/j.1365-2214.2001.00196.x. View

13.

Abbott J, Dodd M, Gee L, Webb K . Ways of coping with cystic fibrosis: implications for treatment adherence. Disabil Rehabil. 2001; 23(8):315-24. DOI: 10.1080/09638280010004171. View

14.

Patey A, Islam R, Francis J, Bryson G, Grimshaw J . Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests. Implement Sci. 2012; 7:52. PMC: 3522997. DOI: 10.1186/1748-5908-7-52. View

15.

Macdonald M, Martin-Misener R, Helwig M, Smith L, Godfrey C, Curran J . Experiences of adults with cystic fibrosis in adhering to medication regimens: a qualitative systematic review. JBI Database System Rev Implement Rep. 2016; 14(5):258-85. DOI: 10.11124/JBISRIR-2016-002362. View

16.

White T, Miller J, Smith G, McMahon W . Adherence and psychopathology in children and adolescents with cystic fibrosis. Eur Child Adolesc Psychiatry. 2008; 18(2):96-104. DOI: 10.1007/s00787-008-0709-5. View

17.

Goldbeck L, Fidika A, Herle M, Quittner A . Psychological interventions for individuals with cystic fibrosis and their families. Cochrane Database Syst Rev. 2014; (6):CD003148. PMC: 7388585. DOI: 10.1002/14651858.CD003148.pub3. View

18.

Lask B . Non-adherence to treatment in cystic fibrosis. J R Soc Med. 1994; 87 Suppl 21:25-7. PMC: 1294262. View

19.

Kwasnicka D, Dombrowski S, White M, Sniehotta F . Data-prompted interviews: Using individual ecological data to stimulate narratives and explore meanings. Health Psychol. 2015; 34(12):1191-4. PMC: 4671473. DOI: 10.1037/hea0000234. View

20.

Kimmel S, Lewis J, Jaskowiak J, Kishel L, Hennessy S . Enhancement of medication recall using medication pictures and lists in telephone interviews. Pharmacoepidemiol Drug Saf. 2003; 12(1):1-8. DOI: 10.1002/pds.764. View