Motivational training improves self-efficacy but not short-term adherence with asthma self-management: a randomized controlled trial.
BACKGROUND
Adherence to self-management in asthma is poor.


OBJECTIVE
To investigate the effect of disease-unspecific motivational training on self-management adherence in addition to asthma-specific patient education.


METHODS
We randomized patients with partly controlled asthma to asthma education, with or without the Zurich Resource Model (ZRM) training. Main elements of the ZRM training are development of action-oriented personal goals and activation of resources to achieve and practice them in daily life. The primary outcome was adherence to self-monitoring and to a written personal action plan during three months. Secondary outcomes included patient-reported self-efficacy.


RESULTS
As control patients (n=30) were younger, mostly male and had better asthma control compared with the intervention group (n=30), we adjusted the analyses for these imbalances. Both groups showed excellent adherence to self-monitoring over three months [27 patients (90.0%) in intervention and 25 patients (83.3%) in control group, adjusted odds ratio: 1.28 (0.24-6.78), P=0.78)]. Patients in the ZRM group tended to adjust their medication more often [median 36% days with action (IQR 11-62%)] than control patients [9% (0-43), P=0.18]. In both groups, actions were rarely in accordance with the action plan [median 20% of actions appropriate (IQR 0-37) in intervention and 11% (IQR 0-56) in control group, P=0.92]. After three months, self-efficacy was significantly better with ZRM (adjusted difference on self-efficacy scale 2.31, 95% CI 0.31-4.31, P=0.02).


CONCLUSIONS
Unspecific self-management training had no short-term effect on self-management adherence in asthma patients. Self-efficacy improved, but it is uncertain whether this translates into better long-term outcomes.
1Department of General Practice and Health Services Research,University of Zurich,Zurich,Switzerland.
Claudia
C
Steurer-Stey
2ZRM Research,Unit of Continuing Education,Department of psychology,University of Zurich,Zurich,Switzerland.
Maja
M
Storch
2ZRM Research,Unit of Continuing Education,Department of psychology,University of Zurich,Zurich,Switzerland.
Susanne
S
Benz
2ZRM Research,Unit of Continuing Education,Department of psychology,University of Zurich,Zurich,Switzerland.
Barbara
B
Hobi
3Centers for Development and Research in Nursing,Department of education and research,University Hospital of Zurich,Zurich,Switzerland.
Barbara
B
Steffen-Bürgi
4Horten Centre for patient-oriented research and knowledge transfer,Department of Internal Medicine,University of Zurich,Zurich,Switzerland.
Johann
J
Steurer
4Horten Centre for patient-oriented research and knowledge transfer,Department of Internal Medicine,University of Zurich,Zurich,Switzerland.
Milo A
MA
Puhan
D000328:Adult; D001249:Asthma / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012648:Self Care / Q000706:statistics & numerical data*; D020377:Self Efficacy