An empirical method to cluster objective nebulizer adherence data among adults with cystic fibrosis

Hoo, Zhe Hui; Campbell, Mike; Curley, Rachael; Wildman, Martin J

doi:10.2147/ppa.s131497

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…In study 1 and 2, PAM-13 scores and levels (1–4) were calculated for participants at baseline and follow-up using the scoring algorithm provided by Insignia. Percentage objective nebuliser adherence was calculated at baseline and follow-up and then categorised as being very low (< 25%), low (25.1–50%), moderate (50.1–75%) or high (> 75%) according to Hoo et al [27].…”

Section: Methodsmentioning

confidence: 99%

“…Nebuliser adherence data were objectively captured with chipped devices (E-track®). Adherence was calculated as a percentage between total amount of medication used against the agreed dose between clinicians and adults with CF and clustered according to a pragmatic algorithm-based clustering method [27]. The most recent 12-month of data in the period from 01 Jan 2016 to 31 Mar 2017 for each potential participant was used for clustering (very low adherence < 25%; low adherence 25.1–50%; moderate adherence 50.1–75%; high adherence > 75%) [27].…”

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confidence: 99%

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Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study

Gao

Arden

Hoo

et al. 2019

BMC Health Serv Res

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Background Patient activation refers to patients’ knowledge, skills, and confidence in self-managing health conditions. In large cross-sectional studies, individuals with higher patient activation are observed to have better health outcomes with the assumption that they are more engaged in health self-management. However, the association between patient activation and objectively measured self-care indicators in individuals can be inconsistent. This research investigated the role of patient activation as measured by the UK Patient Activation Measure (PAM-13) in adults with Cystic Fibrosis (CF). The aims were twofold: to explore how adults with CF interpret and respond to the PAM-13; and to investigate the association between PAM-13 and objectively measured nebuliser adherence in UK adults with CF. Methods This article describes two studies which examined the PAM-13 from different perspectives. Study 1 comprised ‘think aloud’ interviews with 15 adults with CF. The data were analysed using an a priori coding framework. Study 2 examined the association between PAM-13 and objectively measured nebuliser adherence in 57 adults with CF. Results Study 1 showed that adults with CF encountered several difficulties while completing the PAM-13. The difficulties were related to understanding how to interpret aspects of CF in order to respond ( i.e., control over the condition, ability to exercise) and item wording. Some adults with CF responded to the PAM-13 in an optimistic way in relation to what they thought they should do rather than what they actually do. These findings were echoed by the results of Study 2, which showed that PAM-13 scores were not significantly correlated with objective medication adherence in a different sample. This article synthesises the results of both studies, providing insights into influences and associations of patient activation as measured by the UK PAM-13 in adults with CF. Conclusions There were some significant difficulties created by the wording of the UK PAM-13 for adults with CF. This may partly explain the finding that PAM-13 scores were not related to objectively measured nebuliser adherence in this study. The UK PAM-13 would benefit from further research to verify its validity and reliability in different patient populations against objective measures of behaviour rather than simply self-report.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study

Gao

Arden

Hoo

et al. 2019

BMC Health Serv Res

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“… c The percentage values for deprivation and baseline objective adherence add up to 99% due to rounding issues. d Mean unadjusted objective adherence over the previous 6 months measured from chipped i-neb nebulizers: high (≥80.0%), moderate (50.1%-79.9%), low (25.1%-50.0%), and very low (≤25.0%) [ 11 , 27 ]. …”

Section: Methodsmentioning

confidence: 99%

Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study

Drabble¹,

O’Cathain²,

Aj³

et al. 2020

J Med Internet Res

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Background Adherence to nebulizer treatments in adults with cystic fibrosis (CF) is often low. A new complex intervention to help adults with CF increase their adherence to nebulizer treatments was tested in a pilot randomized controlled trial (RCT) in 2 UK CF centers. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time and to a tailored website to display graphs of adherence data and educational and problem-solving information about adherence. A trained interventionist helped patients identify ways to increase their adherence. Objective This study aims to explore the mechanisms of action underpinning the intervention. Methods A qualitative interview study was conducted concurrently with a pilot RCT. In total, 25 semistructured interviews were conducted with 3 interventionists at 2 time points, 14 patients in the intervention arm of the trial, and 5 members of the multidisciplinary teams offering wider care to patients. A framework approach was used for the 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 additional 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. Conclusions The mechanisms of action 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 an RCT in 19 UK CF centers. Trial Registration International Standard Randomized Controlled Trial Number 13076797; http://www.isrctn.com/ISRCTN13076797

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“…The three a priori adherence patterns of interest are 1) people with consistently low adherence (ie, all 3-monthly adherence sections of ≤25%), 2) people with consistently high adherence (ie, all 3-monthly adherence sections of >75%), and 3) everyone else with varying adherence. The use of 3-monthly adherence sections and the ≤25%/>75% thresholds to understand whether adherence is changing over time are based on an adherence clustering algorithm that was previously published 60…”

Section: Methodsmentioning

confidence: 99%

<p>A pragmatic behavior-based habit index for adherence to nebulized treatments among adults with cystic fibrosis</p>

Hoo

Wildman

Campbell

et al. 2019

PPA

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Background Habit, a psychological process that automatically generates urges to perform a behavior in associated settings, is potentially an important determinant of medication adherence. Habit is challenging to measure because, as a psychological construct, it cannot be directly observed. We describe a method of using routinely available objective adherence data from electronic data capture (EDC) to generate a behavior-based index of adherence habit and demonstrate how this index can be applied. Methods to generate the habit index Our proposed habit index is a “frequency in context” measure. It estimates habit as a multiplicative product of behavior frequency (generated from weekly percentage adherence) and context stability (inferred from time of nebulizer use). Although different timescales can be used, we chose to generate weekly habit scores since we believe that this is the most granular level at which context stability can be reasonably calculated. An application of the habit index A hallmark of habit is to predict future behavior, hence we used time series method to cross-correlate the habit index with nebulizer adherence in the subsequent week among 123 adults with cystic fibrosis (52, 42.3% female; median age 25 years) over a median duration of 153 weeks (IQR 74–198 weeks). The mean cross-correlation coefficient ( R ) between the habit index and subsequent adherence was 0.40 (95% CI 0.36–0.44). Adjusting for current adherence, the unstandardized regression coefficient ( B ) for the habit index was 0.30 (95% CI −1.04 to 1.65). Conclusion We have described a pragmatic method to infer “habit” from adherence data routinely captured with EDC and provided proof-of-principle evidence regarding the feasibility of this concept. The continuous stream of data from EDC allows the habit index to unobtrusively assess “habit” at various time points over prolonged periods, and hence the habit index may be applicable in habit formation studies.

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An empirical method to cluster objective nebulizer adherence data among adults with cystic fibrosis

Cited by 7 publications

References 43 publications

Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study

Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study

Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study

<p>A pragmatic behavior-based habit index for adherence to nebulized treatments among adults with cystic fibrosis</p>

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