Respiratory Adherence Care Enhancer Questionnaire: Identifying Self-Management Barriers of Inhalation Corticosteroids in Asthma

Abstract

Introduction: Suboptimal self-management of inhaled corticosteroids (ICS) in asthma patients is frequently observed in clinical practice and associated with poor asthma control. Driving factors for suboptimal self-management are complex and consist of a range of behavioral barriers (cognitive, affective and practical) with a considerable inter-individual variability. Identification of individual barriers facilitates the use of corresponding behavior change techniques and tailored care to improve asthma treatment outcomes.Objective: This study describes the development and validation of the ‘Respiratory Adherence Care Enhancer’ (RACE) questionnaire to identify individual barriers to self-management of ICS therapy in asthma patients.Methods: The development included: 1) an inventory of self-management barriers based on a literature review, 2) expert assessment on relevance and completeness of this set, linking these barriers to behavioral domains of the Theoretical Domains Framework (TDF) and 3) the formulation of corresponding questions assessing each of the barriers. A cross-sectional study was performed for validation. Primary care asthma patients were invited to fill out the RACE-questionnaire prior to a semi-structured telephonic interview as golden standard. Barriers detected from the questionnaire were compared to those mentioned in the interview.Results: The developed questionnaire is made up of 6 TDF-domains, covering 10 self-management barriers with 23 questions. For the validation 64 patients completed the questionnaire, of whom 61 patients were interviewed. Cronbach’s alpha for the consistency of questions within the barriers ranged from 0.58 to 0.90. Optimal cut-off values for the presence of barriers were determined at a specificity between 67 and 92% with a sensitivity between 41 and 83%. Significant Areas Under the Receiver Operating Curves values were observed for 9 barriers with values between 0.69 and 0.86 (p-value <0.05), except for ‘Knowledge of ICS medication’ with an insignificant value of 0.53.Conclusion: The RACE-questionnaire yields adequate psychometric characteristics to identify individual barriers to self-management of ICS therapy in asthma patients, facilitating tailored care.

Self‐management support with the Respiratory Adherence Care Enhancer instrument in asthma and chronic obstructive pulmonary disease: An implementation trial

“…39 In previous research the RACE instrument was validated with asthma patients. 12 This study also confirms its application for COPD patients with comparable patient recognition of the identified individual barrier profiles identified with the RACE questionnaire; 86.1% (±11.8%) in asthma and 81.8% (±13.7%) in COPD. Overall, approximately 4 barriers to self-management were identified per patient in consultations with a mean patient recognition of 51.4% (±29.2%) for each of the identified barriers.…”

“…Barrier presence or absence was determined with defined cut-off values in previous research. 12 The available Control of Allergic Rhinitis and Asthma Test (CARAT10) and Clinical COPD Questionnaire were added to the RACE questionnaire, consisting of 10 questions, to assess disease control for asthma and COPD, respectively. 28,29 Another 8 close-ended questions were added to the questionnaire at baseline for the assessment of socio-demographic and inhalation medication related characteristics.…”

“…In previous research we developed the Respiratory Adherence Care Enhancer (RACE) instrument, facilitating self-management support of controller inhalation therapy with tailored care. 12 The Theoretical Domains Framework (TDF) was applied, which is based on a synthesis of psychological theories aimed at behaviour change. 13,14 The instrument consists of a validated online psychometric questionnaire for the identification of 10 common barriers to self-management in asthma related to 6 key TDF domains: beliefs; emotions; knowledge; behavioural regulation; memory, attention and decision; and skills.…”

“…13,14 The instrument consists of a validated online psychometric questionnaire for the identification of 10 common barriers to self-management in asthma related to 6 key TDF domains: beliefs; emotions; knowledge; behavioural regulation; memory, attention and decision; and skills. 12 This concise set of barriers has been associated with decreased selfmanagement, adherence and poor treatment outcomes in asthma and COPD patients. Its clinical relevance has been verified by primary care healthcare professionals.…”

“…Its clinical relevance has been verified by primary care healthcare professionals. 12,15,16 Behaviour change techniques (BCTs) have been selected and interconnected to the TDF domains to provide barrier-specific evidence-based interventions. These techniques form the active ingredients and delivery procedures of interventions, designed to enhance the effectiveness, replicability and implementation of existing interventions to guidelines facilitating behaviour change in clinical practice.…”