Determinants of objective adherence to nebulised medications among adults with cystic fibrosis: an exploratory mixed methods study comparing low and high adherers
Open accessAbstract
Objectives: Adherence to nebulised treatment is typically low among people with cystic fibrosis (CF). This study sought to identify factors differentiating high or low nebuliser adherence patterns (i.e. ≥80% or <50% of all nebulised treatments over one year) among adults with CF.Design: A mixed methods cross-sectional exploratory comparison of low and high adherers to nebulised medications.Methods: Of 36 eligible adults invited from a UK CF centre, 20 were recruited (10 high, 10 low adherers). Adherence was objectively measured using electronic data capture. Participants completed a self-report questionnaire comprising measures of hypothesised predictors (habit, self-control, life chaos, perceived treatment burden, capability, motivation and opportunity), then took part in a semi-structured interview. Quantitative data were compared between groups, and interview data were thematically analysed.Results: High adherers reported stronger habit and greater opportunities, though habit and perceived opportunity scores were highly positively correlated. No other quantitative measure distinguished between groups. Habitual instigation tendency attenuated the relationship between treatment complexity and perceived treatment burden. Indeed, in interviews, high adherers reported that routinisation and greater automaticity made treatment burden more manageable.Conclusions: High adherers seized more opportunities for nebuliser use, adapted their lives more effectively to using nebulisers and were more likely to make nebuliser use habitual. Nebuliser adherence interventions among adults with CF might usefully target development of routines for instigating nebuliser use, and identification of opportune moments for nebuliser use.
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Objective adherence data collected using date-and time-logging nebulisers have demonstrated that, amongst adolescents with CF, adherence to inhaled therapies is greater on school days compared to weekends or holidays.
“Objective adherence data, collected using date-and time-logging nebulisers, have demonstrated that, amongst adolescents with CF, adherence to inhaled therapies is greater on school days compared to weekends or holidays (Ball 2013), despite this being a time when adolescents are likely to be busiest and are therefore more susceptible to miss treatments due to burden (Hoo 2017).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Hoo 2017
Treatment beliefs and concerns (conscious or reflective motivation) may be an important influence on treatment-taking, and automatic motivation influences, including habit, are also important for adherence to inhaled therapies in adults with CF.
“Whilst treatment beliefs and concerns (i.e.conscious or reflective motivation) may be an important influence on treatment-taking, it is also important to consider the role of automatic motivation influences, with recent trials highlighting the role of habit (i.e.”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Hoo 2017
The results may be consistent with previous research highlighting the role of habit on adherence to inhaled therapies in people with cystic fibrosis, and with the suggestion that habit may attenuate the relationship between treatment complexity and perceived treatment burden.
“This may be consistent with previous research highlighting the role of habit on adherence to inhaled therapies in people with CF (Arden 2019;Ball 2013;Hoo 2017;Hoo 2019a), and the suggestion that habit (i.e.”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Hoo 2017
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The role of beliefs in predicting adherence to nebulised therapy in adolescents with cystic fibrosis
Stirzaker, B. M. (2020) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
- Authors
- Hoo, Z. H., Boote, J., Wildman, M. J., Campbell, M. J., & Gardner, B.
- Affiliations
- Northern General Hospital (GB)
- University of Hertfordshire (GB)
- University of Sheffield (GB)
- King's College London (GB)
- Corresponding author
- Hoo, Z. H.
- Venue
- Health Psychology and Behavioral Medicine
- Publisher
- Informa UK Limited
- Published
- 2017-01
- Volume
- 5
- Issue
- 1
- Pages
- 299-316
- ISSN
- 2164-2850 (ISSN-L)
- OpenAlex
- W2624823979
- Cited by
- 21
- References
- 62
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2
- FWCI
- 2.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Health Psychology and Behavioral Medicine (publishedVersion, cc-by)
- Research Portal (King's College London) (publishedVersion, cc-by-nc)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute for Health Research (DRF-2014-07-092)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- cystic fibrosis, objective adherence measurement, habit, self-control, treatment complexity, opportunity, adults with chronic illness, adherence interventions, routinization
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