Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review.
We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease.



We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. "Effective" studies were those with p < 0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias.



12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2-5 sessions (n = 26,45%) for 1-3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies.



Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.
Centre for Research in Evidence-based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia. Electronic address: amccullo@bond.edu.au.
Amanda R
AR
McCullough
School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.
Crístín
C
Ryan
Centre for Research in Evidence-based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
Christopher
C
Macindoe
Centre for Research in Evidence-based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
Nathan
N
Yii
School of Medicine, Biomedical Sciences and Dentistry, Queen's University Belfast, Belfast, UK.
Judy M
JM
Bradley
Centre for Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health Research, Ulster University, Jordanstown, UK.
Brenda
B
O'Neill
School of Medicine, Biomedical Sciences and Dentistry, Queen's University Belfast, Belfast, UK.
J Stuart
JS
Elborn
School of Pharmacy, Queen's University Belfast, Belfast, UK.
Carmel M
CM
Hughes
D001521:Behavior Therapy / Q000379:methods*; D002908:Chronic Disease; D003657:Decision Making; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012120:Respiration Disorders / Q000523:psychology* / Q000628:therapy; D000073278:Self-Management; D000074822:Treatment Adherence and Compliance / Q000523:psychology*
Adherence; Behavior; Respiratory; Systematic review; Theory