UBC Theses and Dissertations
Medication adherence in asthma : a systematic review and concurrent mixed methods studies exploring the impact of text messages on self-reported medication adherence Gorrin, Nelson
Background: Despite the availability of effective therapy, health outcomes are poor and costs associated with asthma are high. Consistent reports of sub-optimal medication adherence among adults with asthma highlight the importance of assessing the effect of interventions on medication adherence and exploring possible mechanisms to better understand how medication adherence can be promoted and supported. Objectives: My objectives are to review the effects of interventions to improve asthma outcomes on medication adherence and to explore the impacts of text message supported interventions on self-reported medication adherence using a mixed methods approach. Methods: For the systematic review, I conducted a search of databases to identify randomized controlled trials of interventions to improve asthma outcomes using medication. A structured framework was applied to classify interventions based on the emphasis placed on medication adherence. Furthermore, I conducted two convergent mixed methods studies integrating qualitative findings with medication adherence results nested within two studies to improve asthma outcomes. Results: 61 RCTs testing interventions to improve asthma outcomes using medication were identified with variable degree of emphasis placed on medication adherence. The systematic review showed that medication adherence can be effectively promoted if it is seen as objective by researchers. However, improvements observed in medication adherence could not be translated into better health outcomes. These contradictory findings could reveal limitations of RCTs to show some effects in clinical epidemiology. Self-reported medication adherence changes observed in the two nested mixed methods studies could be elucidated by differences in their settings as showed by the integration with a patient-centered model that emerged from the interviews with participants. To my knowledge, this is the first investigation that integrates a patient-centered model with self-reported medication adherence to expand our understanding of medication taking behaviours and generate recommendations for future interventions to improve medication adherence in asthma. Conclusion: This thesis shows how inconclusive results of RCTs to test interventions to improve asthma outcomes are not sufficient to provide answers for all questions. The integration of patients’ perspectives into the equation could bring some clarity into the problem and generate possible solutions for the complex phenomenon of medication non-adherence in asthma.
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