Daily use of inhaled preventer medication is recommended for most people with asthma. However, research suggests many do not adhere to this regime. The current thesis comprises two research studies utilising the common-sense model of self-regulation as the theoretical basis to explore how people make decisions about inhaled preventer use in asthma. The purpose of Study One was to compare a self-report and an objective measure of adherence to preventer medication for asthma and to examine the illness representations and treatment beliefs associated with these measures. Accordingly, 1,936 U.K. General Practice patients who were using preventer medication for asthma completed a questionnaire assessing illness and medication perceptions and gave consent for information to be obtained from their medical records. Adherence to preventer medication was calculated from the Medication Adherence Report Scale (MARS) and an objective measure, the proportion of prescribed medication that the participant collected over the previous year. Results show that nearly nine out of ten participants (88.4%) reported some non-adherence to their preventer medication. The most common form of non-adherence was using preventer inhaler only when feeling breathless. The relationships between participants’ representations of their asthma and their beliefs about their preventer medication and adherence measures were tested using structural equation modelling. Seeing asthma as a condition that was not present when asymptomatic was associated with more non-adherence (β=.22 p<.001) and also with collecting a smaller proportion of prescribed preventer medication over the past year (β=-.15, p<.001). Seeing asthma as an acute condition, as a condition without serious consequences, and as a condition that could not be controlled by treatment were also representations associated with non-adherence. Those who did not see the need for preventer medication at all, or did not see the need for preventer medication when asymptomatic were more likely to be non-adherent. The relationship between illness representations and self-report adherence was mediated by the belief that medication was necessary. Having identified a number of key beliefs that were associated with use of preventer medication in asthma, Study Two explored the way in which these beliefs may be developed through the process of appraisal of the influence of medication use on symptom experience. Using quantitative methods, 77 patients from a New Zealand General Practice completed a questionnaire measuring the reasons for experimenting and stopping medication, illness representations and treatment beliefs. Thirty percent of the sample reported actively experimenting with their medication. These participants were more likely to hold the belief that medication did not help in the absence of symptoms (Mann-Whitney U=343.5, p<.05) and to report trying to avoid thinking about asthma (Mann-Whitney U=330.5, p<.05). Fifty-one of the participants were subsequently interviewed about their experiences with using medication and transcripts of these interviews were subjected to a qualitative analysis. Participants’ responses suggested that the process of appraising whether medication is necessary was influenced by the match between what the participant expects to happen when using the medication and what actually does happen. The process of deciding when medication is necessary is influenced by the threshold at which medication is deemed to be necessary and the speed at which symptoms return if medication is stopped. These findings have implications for the development of interventions to improve adherence to preventer medication for asthma. They suggest that a key component of self-management education is educating patients about the nature of asthma as a chronic condition that is present even in the absence of symptoms. Additionally, they provide evidence that many patients are involved in an active process of appraising the success of their medication. Health professionals should be aware of that this process is likely to be influenced by patients’ expectations of medication, the level of symptoms at which they believe action is required to control asthma and the speed at which symptoms return if medication is discontinued. Future research could take the form of a randomised controlled intervention to assess whether discussion of these factors with patients could improve quality of life for people with asthma. / Whole document restricted, but available by request, use the feedback form to request access.
| Identifer | oai:union.ndltd.org:ADTP/278486 |
| Date | January 2007 |
| Creators | Main, Jodie Jane |
| Publisher | ResearchSpace@Auckland |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Whole document restricted but available by request. Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated., http://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm, Copyright: The author |
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