Medication Adherence in People with Asthma: A Qualitative Systematic Review of Patient and Health Professional Perspectives

Figures & data

Figure 1 PRISMA chart: Searching and screening process.

Table 1 Critical Appraisal of Included Studies

Studies	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Davis et al, 2000^Citation23	U	Y	Y	Y	Y	N	N	Y	U	Y
Walsh et al, 2000^Citation21	Y	Y	Y	Y	Y	N	Y	Y	U	Y
Lindberg et al, 2001^Citation25	U	Y	Y	Y	Y	Y	Y	Y	Y	Y
Scherman & Löwhagen, 2004^Citation30	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Gamble et al, 2007^Citation29	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Peláez et al, 2014^Citation27	N	Y	Y	Y	Y	N	N	Y	Y	Y
George et al, 2015^Citation32	N	Y	Y	Y	Y	N	Y	Y	Y	Y
Peláez et al, 2016^Citation24	N	Y	Y	Y	Y	N	Y	Y	N	Y
Hedenrud et al, 2019^Citation22	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Norful et al, 2020^Citation28	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Ardura-Garcia et al, 2021^Citation26	Y	Y	Y	Y	Y	N	Y	Y	Y	Y
Wadhahi et al, 2022^Citation31	Y	Y	Y	Y	Y	N	Y	Y	Y	Y

Notes: JBI critical appraisal checklist for qualitative research: Q1= Is there congruity between the stated philosophical perspective and the research methodology? Q2= Is there congruity between the research methodology and the research question or objectives? Q3= Is there congruity between the research methodology and the methods used to collect data? Q4= Is there congruity between the research methodology and the representation and analysis of data? Q5= Is there congruity between the research methodology and the interpretation of results? Q6= Is there a statement locating the researcher culturally or theoretically? Q7= Is the influence of the researcher on the research, and vice- versa, addressed? Q8= Are participants, and their voices, adequately represented? Q9= Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Q10= Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?

Abbreviations: Y, yes; N, no; U, unclear; N/A, not applicable.

Table 2 Characteristic of Included Studies

Studies (Author, Year)	Phenomena of Interest	Participants	Methodology Method	Study Setting	Authors Conclusion
Davis et al, 2000^Citation23	To determine the educational needs of primary care physicians, in the management of patients with asthma	52 (19 physicians, 12 pharmacists, 5 respiratory therapists, 16 patients)	A qualitative study Focus group discussions	Canada	There is an urgent need for continuing medical education, not only in management but also in communication with patients and with other members of the health care team.
Walsh et al, 2000^Citation21	To explore those factors that influenced the self-care regimens of asthma sufferers.	35 patients	A phenomenological qualitative study In-depth, free format interviews	UK	Identifying the patients core reciprocal relationship with their doctor reveals the centrality of relationship issues as underlying issues of treatment compliance. The framework of cognitive analytic therapy can be usefully applied to a non-clinical population to good effect.
Lindberg et al, 2001^Citation25	To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient s point of view.	63 patients	A qualitative study Field investigations, and semi-structured interviews	Sweden	The factors of importance for self-reported compliance with prescribed medication were age, duration of the disease, the attitude of the staff and information/education about asthma.
Scherman & Löwhagen, 2004^Citation30	To describe patient experiences of medication.	30 patients	A phenomenological study In-depth, interviews	Sweden	Medication experiences were stable over time. Sociological and biological survival must be compared in an open discussion along with the patient’s and health professional’s different reasons for how they take or prescribe medication.
Gamble et al, 2007^Citation29	To explore the experiences of patients with difficult asthma, who take corticosteroid therapy, and provide insight into why some patients comply with therapy, whilst others do not.	10 patients	A hermeneutic phenomenological approach Unstructured interviews, a multi-step analysis technique	UK	Decision-making was a complex process, involving evaluation of the personal costs and benefits of treatment; fear of side effects was the dominant concern. Compliance with treatment saves lives in this population.
Peláez et al, 2014^Citation27	To examine the perspectives of asthma patients, physicians and allied health professionals regarding adherence to asthma medication.	38 (13 asthma patients, 13 pulmonologist physicians and 12 allied health professionals involved in treating asthma patients)	A qualitative, multiple, collective case study Semi-structured, in-depth interview	Canada	Differences regarding medication adherence and barriers to adherence among the groups examined in the present study will provide insight into how disagreements may be translated to overcome barriers to optimal asthma adherence.
George et al, 2015^Citation32	To identify urban adults’ perceptions of facilitators and barriers to asthma control, including the role of self-care, medications, environmental trigger remediation, and primary care.	35 patients	A qualitative study In-person, semi-structured open-ended qualitative interviews	USA	Personal health beliefs about control can undermine adherence to medical and environmental remediation advice and likely contributes to high rates of uncontrolled asthma in this population. Clinicians need to know whether, and to what degree, these health beliefs can be modified.
Peláez et al, 2016^Citation24	To understand how patients‟ long-term asthma controller medication adherence may be improved and facilitated by comparing key asthma stakeholders‟ perspectives.	38 (13 patients, 13 pulmonologist physicians, and 12 allied healthcare professionals)	A qualitative, multiple-case study Focus group interviews, thematic analysis	Canada	To improve asthma medication adherence, we should: (a) understanding patients experiences and negotiating the treatment regimen, rather than imposing recommendations; (b) considering treatment as a shared responsibility between the patient and the healthcare professional; (c) considering different stakeholders concerns, needs, perspectives, and knowledge.
Hedenrud et al, 2019^Citation22	To explore self-perceived barriers to medical treatment among individuals with asthma within the framework of AAAQ (availability, accessibility, acceptability and quality).	14 patients	A qualitative study Face-to-face interview	Sweden	The inadequate information/education of patients leading to knowledge gaps about both disease and the effect of medicines, and also the perceived unsatisfactory treatment at the PHCC, which could partly be counteracted if patients know what to expect from health care visits.
Norful et al, 2020^Citation28	To explore how Black adults with uncontrolled asthma and their primary care providers communicated about Inhaled corticosteroids (ICS) non-adherence and used shared decision-making to identify strategies to increase ICS use.	80 patients	A grounded theory methodology. Self-reported ICS adherence on the Medication Adherence Report Scale, and clinic visit observations and audio records	USA	Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence.
Wadhahi et al, 2022^Citation31	To provide a description of the adherent behavior to asthma medication among young adults between the age of 18–34 years.	6 patients	A phenomenology study Semi-structured phone or video interviews	Australia	Asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief.
Ardura-Garcia et al, 2021^Citation26	To explore the barriers and facilitators to asthma care access from caregivers’ and HCP’s perspective in an Ecuadorian low-resource setting.	32 (20 caregivers, 3 pediatricians, 6 general doctors and 3 respiratory therapists)	A qualitative study using a general inductive approach and an interpretative phenomenological analysis. Focus group discussions and in-depth interviews	Australia	Multiple barriers identified by caregivers and HCPs referred to economic and health service organisational issues, fear of side effects of medication or ineffective self-management.

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