Drabble, S. orcid.org/0000-0001-7183-6321, O'Cathain, A., Scott, A.J. et al. (5 more authors) (2020) Mechanisms of action of a web-based intervention with health professional support to increase nebulizer adherence in adults with Cystic Fibrosis : a qualitative interview study. Journal of Medical Internet Research, 22 (10). e16782. ISSN 1439-4456
Abstract
Background:
Adherence to nebulizer treatments in adults with cystic fibrosis is often low. A new complex intervention to help adults with cystic fibrosis increase adherence to nebulizer treatments was tested in a pilot randomized controlled trial in two UK cystic fibrosis centers. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time, and a tailored website to display graphs of adherence data and educational and problem solving information about adherence. A trained interventionist helped patients to identify ways to increase their adherence.
Objective:
To explore the mechanisms of action of this complex intervention.
Methods:
A qualitative interview study undertaken concurrently with a pilot randomized controlled trial. 25 semi-structured interviews were conducted with three interventionists at two time points, 14 patients in the intervention arm of the trial, and five members of the multidisciplinary teams offering wider care to patients. A framework approach was used for analysis.
Results:
The intervention was informed by a theoretical framework of behavior change. There was evidence of the expected behavior change mechanisms of action. There was also evidence of Vassilev’s mechanisms of action associated with effective telehealth interventions for self-management support: relationships, visibility, and fit. Patients described how building a relationship with the interventionist through face-to-face visits with someone who cared about them and their progress helped them to consider ways of increasing adherence to medication. Rather than seeing the visibility of adherence data to clinicians as problematic, patients found this motivating, particularly if they received praise about progress made. The intervention was tailored to individuals but there were challenges in how the intervention fitted into some patients’ busy lives when delivered through a desktop computer.
Conclusion:
Mechanisms associated with effective telehealth interventions for self-management operated within this new intervention. The intervention was modified to strengthen mechanisms of action based on these findings, for example delivery through an app accessed via mobile phones, and then tested in a randomized controlled trial in 19 UK cystic fibrosis centers.
Trial registration: ISRCTN13076797
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. |
Keywords: | UK; cystic fibrosis; adherence; behaviour change; process evaluation; qualitative; interviews; digital intervention |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number NATIONAL INSTITUTE FOR HEALTH RESEARCH UNSPECIFIED |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 08 Jul 2020 10:34 |
Last Modified: | 16 Oct 2020 06:27 |
Status: | Published |
Publisher: | JMIR Publications |
Refereed: | Yes |
Identification Number: | 10.2196/16782 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:162976 |