Experiences of Adherence Assessment in Asthma

Background and Aims: Poor adherence to inhaled corticosteroids is understood
to be one of the largest contributors to problematic severe asthma in children
(Bracken et al., 2009). Researchers have sought to understand and target nonadherence
and assessment of adherence is seen as crucial in this process.
Recent research has championed electronic monitoring tools as the “gold
standard” for accurately measuring adherence and these devices have been
extensively evaluated (Burgess, Sly, Devadason, 2011). Only a small amount
of literature has considered how one experiences the process of adherence
assessment through electronic tools. One such device, the smart-inhaler has
been introduced in the paediatric asthma team at the Royal Brompton Hospital.
The proposed study aims to explore young people’s experiences of having their
adherence to inhaled corticosteroids assessed through a smart-inhaler. It will
also explore the experiences of their caregivers and healthcare professionals.
Method: Semi-structured interviews were conducted with eight young people
with asthma, aged 11-15, who had been given a smart-inhaler as part of their
care at the Royal Brompton Hospital, and eight of their caregivers. A focus
group with seven healthcare professionals who used the smart-inhalers in their
practice was also carried out. Interviews were analysed using a critical realist
thematic analysis.
Results: Three themes were identified: “they were trying to help me get better”,
“it’s clearly just to check up” and “who is responsible?”. They highlight the
variety of perspectives and experiences participants had regarding the smartinhaler.
More specifically the themes highlighted the importance of participants’
priorities in influencing their experiences, the impact of the smart-inhaler on the
healthcare relationship and on the transferring of responsibility for asthma to
young people.
Conclusions: The findings suggest that it is important for healthcare
professionals to engage in a shared decision-making process with their patients
when introducing healthcare interventions such as the smart-inhaler.