Patient Preference and Adherence (Mar 2022)
Objective Nebuliser Adherence Data as “Proof” of Adherence in the Management of Cystic Fibrosis: A Qualitative Interview Study
Abstract
Elizabeth Lumley,1 Sarah J Drabble,1 Anne Scott,2 Martin J Wildman,3 Alicia O’Cathain1 1Health and Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK; 2Clinical Trials Research Unit, University of Sheffield, Sheffield, UK; 3Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKCorrespondence: Elizabeth Lumley, Health and Care Research Unit, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK, Tel +44 114 2224294, Email [email protected]: Low adherence to medication via nebulisers is linked to poor clinical outcomes for people with Cystic Fibrosis (PWCF). Advances in technology allow electronic monitoring of nebuliser usage and feedback of objective adherence data to PWCF and clinical teams caring for them. CFHealthHub is a new intervention that collects and displays objective adherence data in easy-to-read formats with the aim of improving nebuliser adherence and health. There is little understanding of how objective adherence data is perceived by PWCF and healthcare professionals (HCPs).Patients and Methods: A qualitative study using semi-structured interviews with 22 PWCF and 31 HCPs who had used the CFHealthHub intervention.Results: Objective adherence data was welcomed by the majority of PWCF in the sample, and HCP delivering the intervention, because the data allowed PWCF to reflect on patterns of adherence or non-adherence. Ease of use and characteristics of data display were important, particularly the use of a “traffic light” system to allow PWCF to easily see if they were meeting their adherence targets. For PWCF objective adherence data was used as “proof to self”, offering reassurance to high adherers, and a wake-up call to those with lower levels of adherence. It could also provide ‘proof to others’ where PWCF had higher levels of adherence than HCP or family members believed. The data could sometimes change HCP perceptions of PWCF’s identities as poor adherers. Where adherence was not high, data was used to facilitate honest discussions between PWCF and HCPs about how to increase adherence. HCPs perceived that it was important to use the data positively to motivate, rather than criticise, PWCF.Conclusion: Objective nebuliser adherence data in CFHealthHub can offer proof of adherence to PWCF and HCPs. It is important to use it constructively to facilitate discussions on how to improve adherence.Keywords: nebulised therapy, behaviour change, non-adherence, subjective reports, compliance, electronic capture
