title: Patients' perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy.
abstract: BACKGROUND
  Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients' insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions.
  
  
  METHODS
  We conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients' perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach.
  
  
  RESULTS
  Patients were aged 2-76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility.
  
  
  CONCLUSIONS
  We identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients' adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions.
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. sandra.pelaez@mail.mcgill.ca.
authors.forename: Sandra
authors.initials: S
authors.lastname: Peláez
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. alexandrine.lamontagne@recherche-ste-justine.qc.ca.
authors.forename: Alexandrine J
authors.initials: AJ
authors.lastname: Lamontagne
authors.affiliation: Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada. johanne.collin@umontreal.ca.
authors.forename: Johanne
authors.initials: J
authors.lastname: Collin
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. gauann@gmail.com.
authors.forename: Annie
authors.initials: A
authors.lastname: Gauthier
authors.affiliation: Department of Family Medicine, Jewish General Hospital, Montreal, Quebec, Canada. roland.grad@mcgill.ca.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Grad
authors.affiliation: Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada. lucie.blais@umontreal.ca.
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.affiliation: Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada. kiml_lavoie@yahoo.ca.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Department of Exercise Sciences, Concordia University, Montreal, Quebec, Canada. simon.bacon@concordia.ca.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.affiliation: Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada. pierre.ernst@mcgill.ca.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. pierre.ernst@mcgill.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.affiliation: Institut national d'excellence en santé et en services sociaux, Quebec, Quebec, Canada. Helene.Guay@inesss.qc.ca.
authors.forename: Hélène
authors.initials: H
authors.lastname: Guay
authors.affiliation: Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada. martha.mckinney.hsj@ssss.gouv.qc.ca.
authors.forename: Martha L
authors.initials: ML
authors.lastname: McKinney
authors.affiliation: Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. francine.m.ducharme@umontreal.ca.|Departments of Pediatrics and of Social and Preventive Medicine, Associate Director of Clinical Research, Research Centre, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7939, Montreal, Quebec, H3T 1C5, Canada. francine.m.ducharme@umontreal.ca.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Ducharme
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D001294:Attitude to Health; D003142:Communication; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D057240:Patient Preference; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research; D012648:Self Care; D012944:Social Support; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones