Implementing the use of objective medication adherence data in routine clinical practice via the digital CFHealthHub platform: situation analysis and strategy development using the theoretical domains framework

Carla Girling,Anna Packham,Martin J Wildman,Louisa Robinson,Daniel Hind,Madelynne A Arden

doi:10.1186/s43058-022-00263-9

Abstract

BackgroundPreventative inhaled treatments preserve lung function and reduce exacerbations in cystic fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients and clinicians to display real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support.MethodsIn this paper, we identify pre-implementation barriers to healthcare practitioners performing two key behaviours: accessing objective adherence data through the website CFHealthHub and discussing medication adherence with patients. We aimed to understand barriers during the pre-implementation phase, so that appropriate strategy could be developed for the scale up of implementing objective adherence data in 19 CF centres.Thirteen semi-structured interviews were conducted with healthcare practitioners working in three UK CF centres. Qualitative data were coded using the theoretical domains framework (TDF), which describes 14 validated domains to implementation behaviour change.ResultsAnalysis indicated that an implementation strategy should address all 14 domains of the TDF to successfully support implementation. Participants did not report routines or habits for using objective adherence data in clinical care. Examples of salient barriers included skills, beliefs in consequences, and social influence and professional roles. The results also affirmed a requirement to address organisational barriers. Relevant behaviour change techniques were selected to develop implementation strategy modules using the behaviour change wheel approach to intervention development.ConclusionsThis paper demonstrates the value of applying the TDF at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy.

Highlights

Preventative inhaled treatments preserve lung function and reduce exacerbations in cystic fibrosis (CF)
This paper demonstrates the value of applying the theoretical domains framework (TDF) at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy
Research indicates that the implementation of healthcare innovations may be more likely to succeed when context and theory are taken into consideration

Summary

Introduction

Preventative inhaled treatments preserve lung function and reduce exacerbations in cystic fibrosis (CF). Self-reported adherence to these treatments is over-estimated. Preventative inhaled treatments preserve lung function by reducing infections [2,3,4,5,6,7,8,9]. Low adherence to these treatments is associated with exacerbations and decreases in lung function [10,11,12,13,14,15]. Low adherence is largely invisible to care teams, who are unable to provide appropriate support to those who need it

Objectives

Methods

Results

Discussion

Conclusion