title: Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma.
abstract: BACKGROUND
  Asthma guidelines advise addressing adherence at every visit, but no simple tools exist to assist clinicians in identifying key adherence-related beliefs or behaviours for individual patients.
  
  
  OBJECTIVE
  To identify potentially modifiable beliefs and behaviours that predict electronically recorded adherence with controller therapy.
  
  
  METHODS
  Patients aged ≥ 14 years with doctor-diagnosed asthma who were prescribed inhaled corticosteroid/long-acting β(2)-agonist (ICS/LABA) completed questionnaires on medication beliefs/behaviours, side-effects, Morisky adherence behaviour score and Asthma Control Test (ACT), and recorded spirometry. Adherence with ICS/LABA was measured electronically over 8 weeks. Predictors of adherence were identified by univariate and multivariate analyses.
  
  
  RESULTS
  99/100 patients completed the study (57 female; forced expiratory volume in 1 s mean ± standard deviation 83 ± 23% predicted; ACT 19.9 ± 3.8). Mean electronically recorded adherence (n= 85) was 75% ± 25, and mean self-reported adherence was 85% ± 26%. Factor analysis of questionnaire items significantly associated with poor adherence identified seven themes: perceived necessity, safety concerns, acceptance of asthma chronicity/medication effectiveness, advice from friends/family, motivation/routine, ease of use and satisfaction with asthma management. Morisky score was moderately associated with actual adherence (r=-0.45, P < 0.0001). In regression analysis, 10 items independently predicted adherence (adjusted R(2) = 0.67; P < 0.001). Opinions of friends/family about the patient's medication use were strongly associated with poor adherence. Global concerns about ICS/LABA therapy were more predictive of poor adherence than were specific side-effects; the one-third of patients who reported experiencing side-effects from their steroid inhaler had lower adherence than others (mean 62% vs 81%; P= 0.015).
  
  
  CONCLUSIONS
  This study identified several specific beliefs and behaviours which clinicians could use for initiating patient-centred conversations about medication adherence in asthma.
authors.affiliation: Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia. j.m.foster@woolcock.org.au
authors.forename: J M
authors.initials: JM
authors.lastname: Foster
authors.forename: L
authors.initials: L
authors.lastname: Smith
authors.forename: S Z
authors.initials: SZ
authors.lastname: Bosnic-Anticevich
authors.forename: T
authors.initials: T
authors.lastname: Usherwood
authors.forename: S M
authors.initials: SM
authors.lastname: Sawyer
authors.forename: C S
authors.initials: CS
authors.lastname: Rand
authors.forename: H K
authors.initials: HK
authors.lastname: Reddel
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy*; D003430:Cross-Sectional Studies; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data; D025341:Principal Component Analysis; D011446:Prospective Studies; D057566:Self Report