Understanding nebuliser adherence in adults with Cystic Fibrosis: comparing high, medium and low adherers

Abstract

Background: Cystic Fibrosis (CF) is a genetic condition that causes lung damage. Nebulised medication is prescribed but adherence is poor. Understanding the differences between people who adhere to their treatment and those who do not is essential to enable us to develop effective interventions. This study used objective measures of adherence to compare high (≥80%), medium (50-79%) and low adherers (<50%) on a range of measures. Methods: Sixty-four participants completed questionnaires: Beliefs about Medicines questionnaire (BMQ-specific), intention, confidence, treatment burden (CFQ-R), life chaos (CHAOS), habit (SRBAI), and subjective adherence (%). Each was provided with an eTrack nebuliser (PARI) which collected objective data about the number of treatments taken over the following 14 day period. Results: High adherers had stronger necessity beliefs and intentions to adhere than low adherers (ps < 0.05). Low adherers reported more life chaos than medium and high adherers (ps < 0.05) and were less confident that they could adhere (ps < 0.01). Habits were stronger in high adherers than medium and low adherers (ps < 0.05). Low adherers reported optimistic subjective adherence compared to high adherers who were more pessimistic (p < 0.001). There were no group differences for concern beliefs or perceived treatment burden. Conclusion: Results from this exploratory study indicated that interventions to increase nebuliser adherence might usefully focus on the development of realistic assessments of adherence (feedback), beliefs about the necessity of treatment, motivation and confidence, and the development of habits. This work has fed into the development of the CFHealthHub adherence intervention.