Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists

Sarah C E Chapman; Neil Barnes; Mari Barnes; Andrea Wilkinson; John Hartley; Cher Piddock; John Weinman; Rob Horne

doi:10.1136/bmjopen-2014-007354

Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists

Sarah C E Chapman, Neil Barnes, Mari Barnes, Andrea Wilkinson, John Hartley, Cher Piddock, John Weinman, Rob Horne

Department of Life Sciences

Research output: Contribution to journal › Article › peer-review

18 Citations (SciVal)

Abstract

OBJECTIVES: The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations.

DESIGN: Pre-post intervention study.

SETTING: Secondary care.

PARTICIPANTS: Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female).

INTERVENTION: Asthma nurse specialists attended a 1.5-day NCF briefing.

PRIMARY AND SECONDARY OUTCOME MEASURES: Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery.

RESULTS: After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (p<0.05), but the intervention was not applied extensively enough to improve adherence.

CONCLUSIONS: The intervention changed nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations.

Original language	English
Article number	e007354
Journal	BMJ Open
Volume	5
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2014-007354
Publication status	Published - 5 Jun 2015

Keywords

Administration, Inhalation
Adrenal Cortex Hormones
Adult
Asthma
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Medication Adherence
Middle Aged
Nurse Clinicians
Patient Education as Topic
Journal Article
Research Support, Non-U.S. Gov't

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@article{e55f414dcac040eeb3d651778b6f8d9a,

title = "Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists",

abstract = "OBJECTIVES: The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations.DESIGN: Pre-post intervention study.SETTING: Secondary care.PARTICIPANTS: Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female).INTERVENTION: Asthma nurse specialists attended a 1.5-day NCF briefing.PRIMARY AND SECONDARY OUTCOME MEASURES: Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery.RESULTS: After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (p<0.05), but the intervention was not applied extensively enough to improve adherence.CONCLUSIONS: The intervention changed nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations.",

keywords = "Administration, Inhalation, Adrenal Cortex Hormones, Adult, Asthma, Feasibility Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Medication Adherence, Middle Aged, Nurse Clinicians, Patient Education as Topic, Journal Article, Research Support, Non-U.S. Gov't",

author = "Chapman, {Sarah C E} and Neil Barnes and Mari Barnes and Andrea Wilkinson and John Hartley and Cher Piddock and John Weinman and Rob Horne",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.",

year = "2015",

month = jun,

day = "5",

doi = "10.1136/bmjopen-2014-007354",

language = "English",

volume = "5",

journal = "BMJ Open",

issn = "2044-6055",

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TY - JOUR

T1 - Changing adherence-related beliefs about ICS maintenance treatment for asthma

T2 - feasibility study of an intervention delivered by asthma nurse specialists

AU - Chapman, Sarah C E

AU - Barnes, Neil

AU - Barnes, Mari

AU - Wilkinson, Andrea

AU - Hartley, John

AU - Piddock, Cher

AU - Weinman, John

AU - Horne, Rob

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/6/5

Y1 - 2015/6/5

N2 - OBJECTIVES: The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations.DESIGN: Pre-post intervention study.SETTING: Secondary care.PARTICIPANTS: Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female).INTERVENTION: Asthma nurse specialists attended a 1.5-day NCF briefing.PRIMARY AND SECONDARY OUTCOME MEASURES: Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery.RESULTS: After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (p<0.05), but the intervention was not applied extensively enough to improve adherence.CONCLUSIONS: The intervention changed nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations.

AB - OBJECTIVES: The Necessity-Concerns Framework (NCF) posits that non-adherence to inhaled corticosteroids (ICS) in asthma is influenced by doubts about the necessity for ICS and concerns about their potential adverse effects. This feasibility study examined whether these beliefs could be changed by briefing asthma nurse specialists on ways of addressing necessity beliefs and concerns within consultations.DESIGN: Pre-post intervention study.SETTING: Secondary care.PARTICIPANTS: Patients with a diagnosis of moderate to severe asthma who were prescribed daily ICS were recruited to either a hospital care group (n=79; 71.0% female) or intervention group (n=57; 66.7% female).INTERVENTION: Asthma nurse specialists attended a 1.5-day NCF briefing.PRIMARY AND SECONDARY OUTCOME MEASURES: Beliefs about ICS (primary outcome) and self-reported adherence were measured preconsultation and 1 month postconsultation. Participants also rated their satisfaction with their consultations immediately after the consultation. Consultation recordings were coded to assess intervention delivery.RESULTS: After the NCF briefing, nurse specialists elicited and addressed beliefs about medicine more frequently. The frequency of using the NCF remained low, for example, open questions eliciting adherence were used in 0/59 hospital care versus 14/49 (28.6%) intervention consultations. Doubts about personal necessity for, and concerns about, ICS were reduced at 1 month postbriefing (p<0.05), but the intervention was not applied extensively enough to improve adherence.CONCLUSIONS: The intervention changed nurse consultations, but not sufficiently enough to fully address non-adherence or adherence-related ICS beliefs (necessity and concerns). More effective techniques are needed to support nurse specialists and other practitioners to apply the intervention in hospital asthma review consultations.

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KW - Adrenal Cortex Hormones

KW - Adult

KW - Asthma

KW - Feasibility Studies

KW - Female

KW - Health Knowledge, Attitudes, Practice

KW - Humans

KW - Male

KW - Medication Adherence

KW - Middle Aged

KW - Nurse Clinicians

KW - Patient Education as Topic

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

UR - https://doi.org/10.1136/bmjopen-2014-007354

U2 - 10.1136/bmjopen-2014-007354

DO - 10.1136/bmjopen-2014-007354

M3 - Article

C2 - 26048207

SN - 2044-6055

VL - 5

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e007354

ER -

Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists

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