title: Changing adherence-related beliefs about ICS maintenance treatment for asthma: feasibility study of an intervention delivered by asthma nurse specialists.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Pre-post intervention study.
  
  
  METHODS
  Secondary care.
  
  
  METHODS
  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).
  
  
  METHODS
  Asthma nurse specialists attended a 1.5-day NCF briefing.
  
  
  METHODS
  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.
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK.
authors.forename: Sarah C E
authors.initials: SC
authors.lastname: Chapman
authors.affiliation: London Chest Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Barnes
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, Kings College, London, UK.
authors.forename: Mari
authors.initials: M
authors.lastname: Barnes
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wilkinson
authors.affiliation: Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hartley
authors.affiliation: Asthma UK 18, London, UK.
authors.forename: Cher
authors.initials: C
authors.lastname: Piddock
authors.affiliation: Institute of Pharmaceutical Sciences & Institute of Psychiatry, Kings College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Weinman
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000451:nursing; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009720:Nurse Clinicians; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D000305:Adrenal Cortex Hormones
keywords: adherence; beliefs; intervention