The Effects of an Education-based Adherence Intervention on Adherence of Inhalation Therapy among Patients with Chronic Respiratory Diseases

• Main Author: To, Ka Wing
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2017
• Subjects: Behavioral psychology; Medicine; Nursing
• ISBN: 9780355599046; 035559904X

Background: Inhalation therapy is the mainstay treatment for patients with chronic respiratory diseases (CRDs). However, patients show poor adherence to recommended inhalation regimens and inhalation techniques, thereby reducing treatment effect and contributing to adverse symptom control, reduced quality of life (QOL), and increased healthcare utilization. Patient education is generally adopted by healthcare professionals to improve medication adherence. Existing studies employ different combinations of interventions to enhance adherence for long-term treatment because of the limited and inconsistent effects of educational intervention alone. However, evidence for their effects is not totally conclusive. Informationmotivation- behavioral skill (IMB) model is recommended as a clear theoretical framework for adherence intervention and is therefore adopted in this study. Systematic review: A systematic review was first performed to examine the effects of various education-based adherence interventions on adherence of inhalation therapy, symptom control, QOL, and healthcare utilization among CRD patients. A total of 16 randomized controlled trials (RCT) involving 2146 adults with CRDs were included in the review. The review showed that the intervention with education alone (n = 3) only significantly improved adherence to inhalation regimen among asthmatic patients. Meanwhile, if the adherence interventions comprised education and behavioral components and employed all three IMB constructs, they exhibited additionally beneficial effects on inhalation techniques, symptom control (n = 2) (SMD = -0.30; 95% CI: -0.56 to -0.04; p = 0.02, at 3-month postintervention), and QOL (n = 2) (SMD = 0.28; 95% CI: 0.02 to 0.53, p = 0.04, at 3-month post-intervention) on top of adherence to inhalation regimen for asthmatic patients. Although the included studies that employed education-behavior-psychosocial interventions together with three IMB constructs were incomparable and inappropriate for data pooling, individual studies demonstrated positive effects on adherence to inhalation therapy, symptom control, QOL, and appeared to reduce healthcare utilization for asthmatic patients especially for those with poorly controlled asthma and poor adherence to treatment. Identification of which combinations of intervention types are best for improving adherence behavior is difficult and depended on the desired behavior and outcomes, as well as characteristics of the participants. The design of the effective education-based adherence interventions can be delivered in individual format and arranged at least three sessions. Aims of pilot study: Due to insufficient evidences on COPD patients, an empirical pilot study has been carried out to examine whether it is feasible to adopt such systematic review findings to a clinical program for COPD patients in Hong Kong, as well as to preliminarily estimate its effects on adherence to inhalation therapy, symptoms, QOL, and healthcare utilization. Pilot Study: A COPD education-based program (IMBEBP) in enhancing adherence of inhalation therapy was designed based on the systematic review results and with the IMB model as a framework. It comprised educational, behavioral and psychosocial components. This pilot study was a single-blinded RCT. After the run-in phase, 30 participants were randomly assigned to either the intervention or control groups. Participants in the intervention group then received an IMBEBP. Data were collected before and six weeks after randomization. The effects of IMBEBP were analyzed by using the generalized estimating equation (GEE) models. Program evaluation was also conducted in the intervention group at the end of program. Key findings of pilot study: The intervention group showed statistically significant results in terms of improved adherence to inhalation regimen and inhalation technique. The program enhanced patients’ awareness of medication adherence and intention to adhere to recommended medication. Conclusion: The systematic review demonstrated that different combinations of education-based adherence interventions exhibited various effects on CRD patients, particularly for asthmatic patients. Additionally, results of the pilot study also showed that implementing IMBEBP adherence intervention in Hong Kong clinical settings was feasible. It might also improve COPD patients’ adherence to their inhalation treatment.