“Knowing how” is not enough: a mixed methods exploration of inhaler technique maintenance in patients with asthma

Abstract

Incorrect inhaler technique maintenance is a persistent problem amongst asthma patients, contributing to poor asthma control. Why inhaler technique deteriorates, even in the absence of identifiable barriers, is unknown. Gaining insight into this problem was the driver behind this thesis. The first study in this thesis identified that patients who were more likely to maintain correct inhaler technique were more likely to: 1) be using a DPI instead of pMDI, 2) have better baseline asthma control, and 3) have higher baseline motivation to practice correct technique [X2 (N=125,3)=16.22, p=0.001]. For the first time, the important role that patient psychosocial factors may play in inhaler technique maintenance was shown. The second study in this thesis provided further insight into relationships between patient psychosocial and behavioural factors in the context of inhaler technique maintenance. Influential factors on patient motivation to maintain correct inhaler technique included: the motivation to engage in asthma management; the motivation to self-manage via a preventative-medication based approach; self-management self-efficacy; and health care professionals’ input. Ensuring optimal inhaler technique maintenance may lie in more holistic approaches to inhaler technique interventions that address, not only physical skill related barriers, but also patient psychosocial barriers in technique maintenance.