Identifying patient-specific beliefs and behaviours for conversations about adherence in asthma

J. M. Foster, L. Smith, S. Z. Bosnic-Anticevich, T. Usherwood, S. M. Sawyer, C. S. Rand, H. K. Reddel

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Background: Asthma guidelines advise addressing adherence at every visit, but no simple tools exist to assist clinicians in identifying key adherence-related beliefs or behaviours for individual patients. Aims: To identify potentially modifiable beliefs and behaviours that predict electronically recorded adherence with controller therapy. Methods: Patients aged ≥14years with doctor-diagnosed asthma who were prescribed inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) completed questionnaires on medication beliefs/behaviours, side-effects, Morisky adherence behaviour score and Asthma Control Test (ACT), and recorded spirometry. Adherence with ICS/LABA was measured electronically over 8weeks. Predictors of adherence were identified by univariate and multivariate analyses. Results: 99/100 patients completed the study (57 female; forced expiratory volume in 1s mean ± standard deviation 83 ± 23% predicted; ACT 19.9 ± 3.8). Mean electronically recorded adherence (n= 85) was 75% ± 25, and mean self-reported adherence was 85% ± 26%. Factor analysis of questionnaire items significantly associated with poor adherence identified seven themes: perceived necessity, safety concerns, acceptance of asthma chronicity/medication effectiveness, advice from friends/family, motivation/routine, ease of use and satisfaction with asthma management. Morisky score was moderately associated with actual adherence (r=-0.45, P < 0.0001). In regression analysis, 10 items independently predicted adherence (adjusted R2= 0.67; P < 0.001). Opinions of friends/family about the patient's medication use were strongly associated with poor adherence. Global concerns about ICS/LABA therapy were more predictive of poor adherence than were specific side-effects; the one-third of patients who reported experiencing side-effects from their steroid inhaler had lower adherence than others (mean 62% vs 81%; P= 0.015). Conclusions: This study identified several specific beliefs and behaviours which clinicians could use for initiating patient-centred conversations about medication adherence in asthma.

Original languageEnglish (US)
Pages (from-to)e136-e144
JournalInternal Medicine Journal
Issue number6
StatePublished - Jun 1 2012


  • Adherence
  • Behaviour
  • Belief
  • Compliance
  • Inhaled corticosteroid
  • Medication
  • Therapy

ASJC Scopus subject areas

  • Internal Medicine


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