Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

Abstract

Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

Factors Influencing Physical Activity Participation among Midlife Immigrant Women: A Systematic Review

“…Nine (41%, 9/22) studies addressed language accommodations specific to the needs of midlife immigrant women participants [ 27 , 28 , 32 , 36 , 37 , 38 , 39 , 40 , 41 ]. A bilingual research team or physical activity instructor who spoke English and the respective language of the participant cohort facilitated language accommodation [ 28 , 32 , 36 , 39 , 40 , 41 ]. Another way that language accommodations were made was by making intervention materials available in the respective languages of participants.…”

“…A lifestyle intervention among Latinas utilized informational brochures available in Spanish that were accessible and easy to read [ 32 ]. Similarly, intervention materials for perimenopausal Latinas made intervention materials available in English and Spanish [ 40 ]. A web-based intervention for Korean–Chinese midlife women included module and program functionalities which were available in English, Mandarin Chinese and Korean [ 37 ].…”

“…Five (23%, 5/22) studies incorporated various logistical adjustments by implementing interventions at convenient locations and appropriate times with features such as childcare services and transportation vouchers [ 27 , 33 , 39 , 40 , 43 ]. Most of the included studies that were conducted in-person took place in convenient settings such as community centers, religious centers and even individual participant homes which were agreed upon by researchers and participants.…”

“…These findings regarding setting convenience were in contrast to the findings of an mHealth physical activity intervention among Korean–Chinese immigrant women, which suggested that home-based or mobile interventions were more feasible for a cohort of midlife immigrant women in place of on-site interventions, due to convenience [ 43 ]. Complimentary services and incentives were also provided to participants throughout the intervention via transportation vouchers and childcare services [ 33 , 40 ]. One study offered childcare services during the intervention sessions for participants with children and offered taxi vouchers for participants with no means of transportation [ 33 ].…”

“…One study offered childcare services during the intervention sessions for participants with children and offered taxi vouchers for participants with no means of transportation [ 33 ]. A physical activity intervention among perimenopausal Latina women provided financial incentives for baseline and subsequent 6-month and 12-month visits, where both transportation vouchers and childcare services were offered to participants [ 40 ].…”