Acceptability of a theory-based adherence intervention for adults with asthma – a person-based approach

Abstract

Objective: Nonadherence to inhaled corticosteroids contributes to poor asthma control. This study evaluated two different theory-based intervention approaches to address nonadherence in adults with asthma using a person-based, qualitative approach to investigate comprehensibility, coherence and acceptability.

Methods: The two intervention approaches addressed treatment beliefs and misconceptions in asthma, aiming to provide a common-sense rationale for medication adherence. Approach one reframed asthma using a concept of balance, the second approach was more traditional presenting medical consequences of nonadherence. We ran three focus group interviews involving 19 adults with asthma to investigate patient acceptability of the intervention approaches and their influence on perceptions of asthma and medication.

Results: Approach one was perceived as novel compared to current practice, logical and easily understandable. Its use of non-medical jargon was perceived as representing information more positively, moving away from stigmatizing people with asthma. Approach two was perceived as not sufficiently novel, not applicable to everyone’s illness experience and triggering fear.

Conclusions: Patient feedback allowed us to refine our intervention strategy prior to running costly feasibility trials. Patient-based approaches for intervention planning may facilitate implementation and acceptability of interventions in practice.

Keywords:

• Asthma
• adherence
• medication beliefs
• intervention
• focus group
• qualitative
• person-based approach
• health psychology

Disclosure statement

ST and VW declare no conflicts of interest. CK and MM have received freelance consultancy fees on previous, unrelated projects for Spoonful of Sugar Limited, a UCL-spin out behavior change consultancy company. AC reports consultancy fees from Janssen-Cilag, and Spoonful of Sugar Ltd, and speaker fees from Novartis, outside the submitted work. RH reports fees from Medical Innovation Academic Consortium (CASMI), AbbVie, Amgen, Biogen, Idec, Gilead Sciences, GlaxoSmithKline, Janssen, Pfizer, Roche, Shire Pharmaceuticals, MSD, Astellas, AstraZeneca, DRSU, Novartis, Universitätsklinikum Hamburg-Eppendorf, and Teva Pharmaceuticals, and is the Founder and Director of Spoonful of Sugar Ltd., outside the submitted work.

Consent for publication

I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story. Informed consent was obtained from all participants to include aggregated data and individual direct quotes in any publications.

Data availability statement

The datasets generated and analyzed during the current study are not publicly available due to restrictions of ethical approvals obtained for this study.

Additional information

Funding

The research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.