Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Objectives

Adherence to nebuliser treatment in adults with Cystic Fibrosis (CF) is poor and interventions are needed. This research aimed to identify the factors affecting nebuliser adherence using the Theoretical Domains Framework and to compare these for participants with different levels of adherence.

Design

Data prompted interviews using the theoretical domains framework.

Methods

Eighteen semi-structured interviews were conducted with adults with CF during which objectively measured adherence data was discussed. Framework analysis was used to code the data into TDF domains and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored.

Results

Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions.

Conclusions

This study is the first to use objectively measured adherence data in a data-prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem-solving may be particularly useful for adults with CF.