Understanding adherence to nebuliser treatment in adults with cystic fibrosis using the Theoretical Domains Framework

Objectives: To identify the factors influencing nebuliser adherence in adults with Cystic Fibrosis (CF) using the Theoretical Domains Framework (TDF) in order to inform the development of a behaviour change intervention. Methods: Interviews were conducted with 18 adults with CF. The interview guide was developed using the TDF to explore nebuliser adherence. During the interview participants were presented with charts of their own nebuliser adherence data, and this was used to prompt discussion. Interview transcripts were content-analysed using the TDF as the coding framework. Results: All 14 theoretical domains were identified as being relevant to nebuliser adherence although the specific domains of influence were variable across individuals. Motivation for treatment was often related to a range of beliefs about the consequences of adherence to treatment, the amount of feedback that they perceived from treatment, and their treatment and other life goals. Capability was often related to knowledge about treatment, the ability to remember to take treatment particularly outside of a normal routine, and the extent to which treatment was planned and monitored. Issues of Opportunity included both facilitatory and inhibitory social influences, and the extent to which the environment and resources facilitated treatment. Conclusion: The TDF allowed for the identification of a range of factors influencing adherence to nebuliser treatment that could be targeted in a future intervention. Interventions should be tailored to the specific Motivation, Capability and Opportunity issues that influence treatment adherence for an individual.