How can adherence to asthma medication be enhanced? Triangulation of key asthma stakeholders' perspectives

Abstract

Background and objectives: Adherence to daily asthma controller medication has been shown to be the most effective component of asthma self-management; however, patient's adherence to asthma medication remains poor. This study aimed to understand how patients' long-term asthma controller medication adherence may be improved and facilitated by comparing key asthma stakeholders' perspectives. Method: Six focus group interviews including 38 asthma stakeholders (n = 13 patients, n = 13 pulmonologist physicians, and n = 12 allied healthcare professionals) were conducted. Interviews were qualitatively analysed. Results: Although similar themes were brought up across different asthma stakeholders, the way in which they were framed differed across stakeholders. The most salient discussion revolved around the content and the moment in which asthma education should be approached to facilitate patients' adherence to asthma medication. Conclusion: Asthma medication adherence is a complex process and successful interventions aimed at its improvement would benefit from: (a) making an effort to understand patients' experiences and negotiate the treatment regimen, rather than imposing recommendations; (b) considering treatment as a shared responsibility involving the patient, the healthcare professional(s), and the patients' social networks; and, (c) taking into account different stakeholders' concerns, needs, perspectives, and knowledge.

Keywords:

• Focus groups
• facilitators
• intervention
• patients
• physicians
• health care professionals
• education

Acknowledgments

This work was presented at the Young Investigators (YI) Forum supported by the Canadian Institutes of Health Research (CIHR) held in June 2012, in Montreal, Quebec, Canada. SP, KLL, GL, and SLB participated in the conception and design of the study. GL coordinated the study including scheduling the interviews, booking the facilities, getting the refreshments, and coordinating the reception of transcriptions of audiotaped interviews. SP and GL contributed to the development of the interview guide, conducted the focus group interviews, and analysed the data. SP led the interpretation of data and drafted the manuscript. KLL, GL, and SLB provided feedback on data analysis and interpretation. All authors read and approved the final manuscript. KLL conceived the protocol, obtained funding, oversaw the study, and therefore assumes the overall responsibility.

Declaration of interests

The authors declare that they have no conflicts of interests. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by an investigator-initiated grant from GlaxoSmithKline (KLL) and New Investigators Awards from the Canadian Institute of Health Research (CIHR) and the Fonds de la Recherche du Quebec - Santé (FRQS) (KLL, SLB).