Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

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.

Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations

“…This was highlighted by Sawicki, Heller, Demars and Robinson [20], who interviewed 20 pairs of CF youth patients (aged 16-21 years old) with their parents and found that patients thought their treatment "makes no difference" to how they felt, which affected their intentions to adhere. These findings have been supported by the work of Arden et al [21], who found that some participants have "dysfunctional beliefs" in terms of believing that adhering to their nebuliser treatment has no impact upon their health. It was also found that some patients reported adhering to treatment when they experienced more symptoms [21], which could suggest a relationship between symptoms experienced and adherence to nebuliser treatments.…”

“…These findings have been supported by the work of Arden et al [21], who found that some participants have "dysfunctional beliefs" in terms of believing that adhering to their nebuliser treatment has no impact upon their health. It was also found that some patients reported adhering to treatment when they experienced more symptoms [21], which could suggest a relationship between symptoms experienced and adherence to nebuliser treatments.…”

When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments

“…ACtiF is a 5-year program to develop and evaluate a theory-based complex intervention to improve nebulizer adherence in adults with CF. The qualitative interview study reported in this article was undertaken at the beginning of the ACtiF program, as the first step in developing an intervention to improve nebulizer adherence, by understanding the barriers and facilitators to nebulizer adherence in adults with CF (Arden et al, 2019). For more information about the intervention and pilot feasibility study, also see the work by Hind et al (2019).…”

“…However, two smaller studies in adult patients have started to question the role of forgetting in adherence behavior, suggesting that nebulizer treatments in adults may be so routinized that forgetting is not an issue (Hogan et al, 2015). In a study of the differences in barriers and facilitators to adherence of nebulizer treatments between high and low adherers, Arden et al (2019) found that forgetting was given as a reason for nonadherence by adults regardless of whether they had high or low adherence, suggesting that addressing forgetting may not be a useful way to improve adherence.…”

Adult Care in Cystic Fibrosis

“…This can lead to difficulties with adherence to treatment, which is very understandable. 63,125 Indeed, it would be unusual for any individual to never miss any of the treatments. Maximizing adherence requires an honest and open relationship with the individual and flexibility from health care practitioners to understand what an individual can do and to help them prioritize their treatment program.…”