Applying the theoretical domains framework to adherence to nebuliser treatment in adults with cystic fibrosis

Abstract

Background: Poor adherence to nebulised treatments in adults with Cystic Fibrosis (CF) is prevalent and related to poor health outcomes. Understanding which factors influence adherence is an important first step in the development of a behaviour change intervention. The Theoretical Domains Framework (TDF) was used to inform this investigation. Methods: Interviews were conducted with 18 adults with CF, purposively selected to represent a range of patient characteristics. An interview guide was developed using the TDF to explore nebuliser adherence. During the interview participants were presented with charts of their own nebuliser adherence data, and this was used to prompt discussion. Interview transcripts were content-analysed using the TDF as the coding framework. Results: All 14 theoretical domains were identified as being relevant to nebuliser adherence, although the specific domains of influence were variable across individuals. Participants expressed; a broad range of 'Beliefs about the consequences' of adhering to treatment and varying 'Knowledge' about treatment; a lack of positive 'Reinforcement' for treatment adherence; difficulties with 'Memory' for treatment and 'Behavioural Regulation'; a range of personal 'Goals' related to, and in conflict with, treatment adherence; facilitatory and inhibitory 'Social influences' and 'Environmental context and resource' issues. Discussion: The TDF allowed for the identification of a range of factors influencing adherence to nebuliser treatment that could be targeted in a future intervention. It was clear that different participants had very different factors influencing their treatment adherence, highlighting the importance of individual tailoring.