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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Motivational foci and asthma medication tactics directed towards a functional day

Authors: Malin Axelsson, Jan Lötvall, Jesper Lundgren, Eva Brink

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

There appears to be an obvious gap between a medical and patient adherence perspective. Deviating from a medication prescription could be regarded as fairly irrational, but with respect to patients' goals and/or concerns it could be seen as understandable. Thus, the aim was to elucidate adherence reasoning in relation to asthma medication.

Methods

This was a qualitative study; data collection and analysis procedures were conducted according to Grounded Theory methodology. Eighteen persons, aged 22 with asthma and regular asthma medication treatment, were interviewed.

Results

The emerged theoretical model illustrated that adherence to asthma medication was motivated by three foci, all directed towards a desired outcome in terms of a functional day as desired by the patient. A promotive focus was associated with the ambition to achieve a positive asthma outcome by being adherent either to the received prescription or to a self-adjusted dosage. A preventive focus was intended to ensure avoidance of a negative asthma outcome either by sticking to the prescription or by preventively overusing the medication. A permissive focus was associated with unstructured adherence behaviour in which medication intake was primarily triggered by asthma symptoms.

Conclusions

As all participants had consciously adopted functioning medication tactics that directed them towards the desired goal of a functional day. In an effort to bridge the gap between a patient- and a medical adherence perspective, patients need support in defining their desired functionality and guidance in developing a person-based medication tactic.
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Literature
1.
go back to reference Epstein RM: The science of patient-centered care. J Fam Pract. 2000, 49 (9): 805-807.PubMed Epstein RM: The science of patient-centered care. J Fam Pract. 2000, 49 (9): 805-807.PubMed
2.
go back to reference Mead N, Bower P: Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000, 51: 1087-1110. 10.1016/S0277-9536(00)00098-8.CrossRefPubMed Mead N, Bower P: Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000, 51: 1087-1110. 10.1016/S0277-9536(00)00098-8.CrossRefPubMed
3.
go back to reference Robinson JH, Callister LC, Berry JA, Dearing KA: Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008, 20 (12): 600-607. 10.1111/j.1745-7599.2008.00360.x.CrossRefPubMed Robinson JH, Callister LC, Berry JA, Dearing KA: Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008, 20 (12): 600-607. 10.1111/j.1745-7599.2008.00360.x.CrossRefPubMed
4.
go back to reference Latry P, Pinet M, Labat A, Magand JP, Peter C, Robinson P, Martin-Latry K, Molimard M: Adherence to anti-inflammatory treatment for asthma in clinical practice in France. Clin Ther. 2008, 30 (Spec No): 1058-1068.CrossRefPubMed Latry P, Pinet M, Labat A, Magand JP, Peter C, Robinson P, Martin-Latry K, Molimard M: Adherence to anti-inflammatory treatment for asthma in clinical practice in France. Clin Ther. 2008, 30 (Spec No): 1058-1068.CrossRefPubMed
5.
go back to reference Krigsman K, Nilsson JL, Ring L: Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions. Pharmacoepidemiol Drug Saf. 2007, 16 (4): 441-448. 10.1002/pds.1321.CrossRefPubMed Krigsman K, Nilsson JL, Ring L: Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions. Pharmacoepidemiol Drug Saf. 2007, 16 (4): 441-448. 10.1002/pds.1321.CrossRefPubMed
6.
go back to reference Gamble J, Stevenson M, McClean E, Heaney LG: The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med. 2009, 180 (9): 817-822. 10.1164/rccm.200902-0166OC.CrossRefPubMed Gamble J, Stevenson M, McClean E, Heaney LG: The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med. 2009, 180 (9): 817-822. 10.1164/rccm.200902-0166OC.CrossRefPubMed
7.
go back to reference Jones C, Santanello NC, Boccuzzi SJ, Wogen J, Strub P, Nelsen LM: Adherence to prescribed treatment for asthma: evidence from pharmacy benefits data. J Asthma. 2003, 40 (1): 93-101. 10.1081/JAS-120017212.CrossRefPubMed Jones C, Santanello NC, Boccuzzi SJ, Wogen J, Strub P, Nelsen LM: Adherence to prescribed treatment for asthma: evidence from pharmacy benefits data. J Asthma. 2003, 40 (1): 93-101. 10.1081/JAS-120017212.CrossRefPubMed
8.
go back to reference Bender BG, Long A, Parasuraman B, Tran ZV: Factors influencing patient decisions about the use of asthma controller medication. Ann Allergy Asthma Immunol. 2007, 98 (4): 322-328. 10.1016/S1081-1206(10)60877-0.CrossRefPubMed Bender BG, Long A, Parasuraman B, Tran ZV: Factors influencing patient decisions about the use of asthma controller medication. Ann Allergy Asthma Immunol. 2007, 98 (4): 322-328. 10.1016/S1081-1206(10)60877-0.CrossRefPubMed
9.
go back to reference Otsuki M, Clerisme-Beaty E, Rand CS, Riekert KA: Measuring adherence to medication regimens in clinical care and research. The handbook of health behavior change. Edited by: Shumaker. 2008, New York: Springer Pub., 309-325. 3 Otsuki M, Clerisme-Beaty E, Rand CS, Riekert KA: Measuring adherence to medication regimens in clinical care and research. The handbook of health behavior change. Edited by: Shumaker. 2008, New York: Springer Pub., 309-325. 3
10.
go back to reference Horn CR, Clark TJ, Cochrane GM: Compliance with inhaled therapy and morbidity from asthma. Respir Med. 1990, 84 (1): 67-70. 10.1016/S0954-6111(08)80097-2.CrossRefPubMed Horn CR, Clark TJ, Cochrane GM: Compliance with inhaled therapy and morbidity from asthma. Respir Med. 1990, 84 (1): 67-70. 10.1016/S0954-6111(08)80097-2.CrossRefPubMed
11.
go back to reference Clatworthy J, Price D, Ryan D, Haughney J, Horne R: The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J. 2009, 18 (4): 300-305. 10.4104/pcrj.2009.00037.CrossRefPubMed Clatworthy J, Price D, Ryan D, Haughney J, Horne R: The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J. 2009, 18 (4): 300-305. 10.4104/pcrj.2009.00037.CrossRefPubMed
12.
go back to reference Williams LK, Pladevall M, Xi H, Peterson EL, Joseph C, Lafata JE, Ownby DR, Johnson CC: Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol. 2004, 114 (6): 1288-1293. 10.1016/j.jaci.2004.09.028.CrossRefPubMed Williams LK, Pladevall M, Xi H, Peterson EL, Joseph C, Lafata JE, Ownby DR, Johnson CC: Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol. 2004, 114 (6): 1288-1293. 10.1016/j.jaci.2004.09.028.CrossRefPubMed
13.
go back to reference Bender BG, Rand C: Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004, 4 (3): 191-195. 10.1097/00130832-200406000-00009.CrossRefPubMed Bender BG, Rand C: Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004, 4 (3): 191-195. 10.1097/00130832-200406000-00009.CrossRefPubMed
14.
go back to reference Adams S, Pill R, Jones A: Medication, chronic illness and identity: the perspective of people with asthma. Social Science & Medicine. 1997, 45 (2): 189-201. 10.1016/S0277-9536(96)00333-4.CrossRef Adams S, Pill R, Jones A: Medication, chronic illness and identity: the perspective of people with asthma. Social Science & Medicine. 1997, 45 (2): 189-201. 10.1016/S0277-9536(96)00333-4.CrossRef
15.
go back to reference Ulrik CS, Backer V, Soes-Petersen U, Lange P, Harving H, Plaschke PP: The patient's perspective: adherence or non-adherence to asthma controller therapy?. J Asthma. 2006, 43 (9): 701-704. 10.1080/02770900600925569.CrossRefPubMed Ulrik CS, Backer V, Soes-Petersen U, Lange P, Harving H, Plaschke PP: The patient's perspective: adherence or non-adherence to asthma controller therapy?. J Asthma. 2006, 43 (9): 701-704. 10.1080/02770900600925569.CrossRefPubMed
16.
go back to reference Laforest L, El Hasnaoui A, Pribil C, Ritleng C, Osman LM, Schwalm MS, Le Jeunne P, Van Ganse E: Asthma patients' self-reported behaviours toward inhaled corticosteroids. Respir Med. 2009, 103 (9): 1366-75. 10.1016/j.rmed.2009.03.010.CrossRefPubMed Laforest L, El Hasnaoui A, Pribil C, Ritleng C, Osman LM, Schwalm MS, Le Jeunne P, Van Ganse E: Asthma patients' self-reported behaviours toward inhaled corticosteroids. Respir Med. 2009, 103 (9): 1366-75. 10.1016/j.rmed.2009.03.010.CrossRefPubMed
17.
go back to reference Loignon C, Bedos C, Sevigny R, Leduc N: Understanding the self-care strategies of patients with asthma. Patient Educ Couns. 2009, 75 (2): 256-262. 10.1016/j.pec.2008.10.008.CrossRefPubMed Loignon C, Bedos C, Sevigny R, Leduc N: Understanding the self-care strategies of patients with asthma. Patient Educ Couns. 2009, 75 (2): 256-262. 10.1016/j.pec.2008.10.008.CrossRefPubMed
18.
go back to reference Menckeberg TT, Bouvy ML, Bracke M, Kaptein AA, Leufkens HG, Raaijmakers JA, Horne R: Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008, 64 (1): 47-54. 10.1016/j.jpsychores.2007.07.016.CrossRefPubMed Menckeberg TT, Bouvy ML, Bracke M, Kaptein AA, Leufkens HG, Raaijmakers JA, Horne R: Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008, 64 (1): 47-54. 10.1016/j.jpsychores.2007.07.016.CrossRefPubMed
19.
go back to reference Horne R, Weinman J: Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002, 17 (1): 17-32. 10.1080/08870440290001502.CrossRef Horne R, Weinman J: Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002, 17 (1): 17-32. 10.1080/08870440290001502.CrossRef
20.
go back to reference Axelsson M, Emilsson M, Brink E, Lundgren J, Torén K, Lötvall J: Personality, adherence, asthma control and health-related quality of life in young adult asthmatics. Respir Med. 2009, 103 (7): 1033-1040. 10.1016/j.rmed.2009.01.013.CrossRefPubMed Axelsson M, Emilsson M, Brink E, Lundgren J, Torén K, Lötvall J: Personality, adherence, asthma control and health-related quality of life in young adult asthmatics. Respir Med. 2009, 103 (7): 1033-1040. 10.1016/j.rmed.2009.01.013.CrossRefPubMed
21.
go back to reference Christensen AJ, Smith TW: Personality and patient adherence: correlates of the five-factor model in renal dialysis. J Behav Med. 1995, 18 (3): 305-313. 10.1007/BF01857875.CrossRefPubMed Christensen AJ, Smith TW: Personality and patient adherence: correlates of the five-factor model in renal dialysis. J Behav Med. 1995, 18 (3): 305-313. 10.1007/BF01857875.CrossRefPubMed
22.
go back to reference Stilley CS, Sereika S, Muldoon MF, Ryan CM, Dunbar-Jacob J: Psychological and cognitive function: predictors of adherence with cholesterol lowering treatment. Ann Behav Med. 2004, 27 (2): 117-124. 10.1207/s15324796abm2702_6.CrossRefPubMed Stilley CS, Sereika S, Muldoon MF, Ryan CM, Dunbar-Jacob J: Psychological and cognitive function: predictors of adherence with cholesterol lowering treatment. Ann Behav Med. 2004, 27 (2): 117-124. 10.1207/s15324796abm2702_6.CrossRefPubMed
23.
go back to reference Ediger JP, Walker JR, Graff L, Lix L, Clara I, Rawsthorne P, Rogala L, Miller N, McPhail C, Deering K, et al: Predictors of medication adherence in inflammatory bowel disease. Am J Gastroenterol. 2007, 102 (7): 1417-1426. 10.1111/j.1572-0241.2007.01212.x.CrossRefPubMed Ediger JP, Walker JR, Graff L, Lix L, Clara I, Rawsthorne P, Rogala L, Miller N, McPhail C, Deering K, et al: Predictors of medication adherence in inflammatory bowel disease. Am J Gastroenterol. 2007, 102 (7): 1417-1426. 10.1111/j.1572-0241.2007.01212.x.CrossRefPubMed
24.
go back to reference Cohen NL, Ross EC, Bagby RM, Farvolden P, Kennedy SH: The 5-factor model of personality and antidepressant medication compliance. Can J Psychiatry. 2004, 49 (2): 106-113.PubMed Cohen NL, Ross EC, Bagby RM, Farvolden P, Kennedy SH: The 5-factor model of personality and antidepressant medication compliance. Can J Psychiatry. 2004, 49 (2): 106-113.PubMed
25.
go back to reference O'Cleirigh C, Ironson G, Weiss A, Costa PT: Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV. Health Psychol. 2007, 26 (4): 473-480.CrossRefPubMed O'Cleirigh C, Ironson G, Weiss A, Costa PT: Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV. Health Psychol. 2007, 26 (4): 473-480.CrossRefPubMed
26.
go back to reference Bruce JM, Hancock LM, Arnett P, Lynch S: Treatment adherence in multiple sclerosis: association with emotional status, personality, and cognition. J Behav Med. 2010, 33 (3): 219-227. 10.1007/s10865-010-9247-y.CrossRefPubMed Bruce JM, Hancock LM, Arnett P, Lynch S: Treatment adherence in multiple sclerosis: association with emotional status, personality, and cognition. J Behav Med. 2010, 33 (3): 219-227. 10.1007/s10865-010-9247-y.CrossRefPubMed
27.
go back to reference McAdams DP, Pals JL: A new Big Five: fundamental principles for an integrative science of personality. Am Psychol. 2006, 61 (3): 204-217.CrossRefPubMed McAdams DP, Pals JL: A new Big Five: fundamental principles for an integrative science of personality. Am Psychol. 2006, 61 (3): 204-217.CrossRefPubMed
28.
go back to reference Higgins ET: Promotion and prevention: Regulatory focus as a motivational principle. Adv Exp Soc Psychol. 1998, 30: 1-46.CrossRef Higgins ET: Promotion and prevention: Regulatory focus as a motivational principle. Adv Exp Soc Psychol. 1998, 30: 1-46.CrossRef
29.
go back to reference Strauss AL, Corbin JM: Basics of qualitative research: techniques and procedures for developing grounded theory. 1998, Thousand Oaks, Calif.: SAGE, 2 Strauss AL, Corbin JM: Basics of qualitative research: techniques and procedures for developing grounded theory. 1998, Thousand Oaks, Calif.: SAGE, 2
30.
go back to reference Bryant A, Charmaz K: Grounded Theory in Historical Perspective: An Epistemological Account. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 31-57. Pbk Bryant A, Charmaz K: Grounded Theory in Historical Perspective: An Epistemological Account. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 31-57. Pbk
31.
go back to reference Morse J: Sampling in Grounded Theory. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 229-244. Pbk Morse J: Sampling in Grounded Theory. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 229-244. Pbk
32.
go back to reference Dellve L, Henning-Abrahamsson K, Trulsson U, Hallberg R-ML: Grounded theory in public health research. Qualitative methods in public health research: theoretical foundations and practical examples. Edited by: Hallberg R-M L. 2002, Lund: Studentlitteratur, 137-170. Dellve L, Henning-Abrahamsson K, Trulsson U, Hallberg R-ML: Grounded theory in public health research. Qualitative methods in public health research: theoretical foundations and practical examples. Edited by: Hallberg R-M L. 2002, Lund: Studentlitteratur, 137-170.
33.
go back to reference Olesen VL: Feminist Qualitative Research and Grounded Theory: Complexities, Criticisms, and Opportunities. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 417-435. Pbk Olesen VL: Feminist Qualitative Research and Grounded Theory: Complexities, Criticisms, and Opportunities. The SAGE handbook of grounded theory. Edited by: Bryant A, Charmaz K. 2010, Los Angeles [i.e. Thousand Oaks, Calif.]: SAGE Publications, 417-435. Pbk
34.
go back to reference Edhlund BM: Allt om NVivo: den bästa hjälpen vid kvalitativ analys. 2007, Stallarholmen: Form & Kunskap Edhlund BM: Allt om NVivo: den bästa hjälpen vid kvalitativ analys. 2007, Stallarholmen: Form & Kunskap
35.
go back to reference Glaser BG, Strauss AL: The discovery of grounded theory: strategies for qualitative research. 1967, New York: Aldine de Gruyter Glaser BG, Strauss AL: The discovery of grounded theory: strategies for qualitative research. 1967, New York: Aldine de Gruyter
36.
go back to reference Steiner JF, Fihn SD, Blair B, Inut TS: Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol. 1991, 44 (12): 1361-1371. 10.1016/0895-4356(91)90097-S.CrossRefPubMed Steiner JF, Fihn SD, Blair B, Inut TS: Appropriate reductions in compliance among well-controlled hypertensive patients. J Clin Epidemiol. 1991, 44 (12): 1361-1371. 10.1016/0895-4356(91)90097-S.CrossRefPubMed
37.
go back to reference Miller LG, Liu H, Hays RD, Golin CE, Beck CK, Asch SM, Ma Y, Kaplan AH, Wenger NS: How well do clinicians estimate patients' adherence to combination antiretroviral therapy?. J Gen Intern Med. 2002, 17 (1): 1-11. 10.1046/j.1525-1497.2002.09004.x.CrossRefPubMedPubMedCentral Miller LG, Liu H, Hays RD, Golin CE, Beck CK, Asch SM, Ma Y, Kaplan AH, Wenger NS: How well do clinicians estimate patients' adherence to combination antiretroviral therapy?. J Gen Intern Med. 2002, 17 (1): 1-11. 10.1046/j.1525-1497.2002.09004.x.CrossRefPubMedPubMedCentral
38.
go back to reference Norell SE: Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Soc Sci Med E. 1981, 15 (1): 57-61. 10.1016/0271-5384(81)90063-6.CrossRefPubMed Norell SE: Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Soc Sci Med E. 1981, 15 (1): 57-61. 10.1016/0271-5384(81)90063-6.CrossRefPubMed
39.
go back to reference Hui CL, Chen EY, Kan CS, Yip KC, Law CW, Chiu CP: Detection of non-adherent behaviour in early psychosis. Aust N Z J Psychiatry. 2006, 40 (5): 446-451. 10.1080/j.1440-1614.2006.01821.x.CrossRefPubMed Hui CL, Chen EY, Kan CS, Yip KC, Law CW, Chiu CP: Detection of non-adherent behaviour in early psychosis. Aust N Z J Psychiatry. 2006, 40 (5): 446-451. 10.1080/j.1440-1614.2006.01821.x.CrossRefPubMed
40.
go back to reference Sherman J, Hutson A, Baumstein S, Hendeles L: Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions. J Pediatr. 2000, 136 (4): 532-536. 10.1016/S0022-3476(00)90019-2.CrossRefPubMed Sherman J, Hutson A, Baumstein S, Hendeles L: Telephoning the patient's pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions. J Pediatr. 2000, 136 (4): 532-536. 10.1016/S0022-3476(00)90019-2.CrossRefPubMed
41.
go back to reference Frampton SB, Charmel PA: Putting patients first: best practices in patient-centered care. 2009, San Francisco: Jossey-Bass, 2 Frampton SB, Charmel PA: Putting patients first: best practices in patient-centered care. 2009, San Francisco: Jossey-Bass, 2
42.
go back to reference Wenzel SE: Asthma: defining of the persistent adult phenotypes. Lancet. 2006, 368 (9537): 804-813. 10.1016/S0140-6736(06)69290-8.CrossRefPubMed Wenzel SE: Asthma: defining of the persistent adult phenotypes. Lancet. 2006, 368 (9537): 804-813. 10.1016/S0140-6736(06)69290-8.CrossRefPubMed
Metadata
Title
Motivational foci and asthma medication tactics directed towards a functional day
Authors
Malin Axelsson
Jan Lötvall
Jesper Lundgren
Eva Brink
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-809

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