A systematic
review
Christina Joanne Pearce1, 2, Amy Hai Yan
Chan1, 2,5, Tracy Jackson2, Louise
Fleming2, 3, 4, Holly Foot5, Andy
Bush2, 3, 4 and Rob Horne1, 2,
Affiliations: 1 School of Pharmacy, Department of
Practice and Policy, University College London, London, Greater London,
United Kingdom, 2 Asthma UK Centre for Applied
Research, 3Paediatric Respiratory Medicine, Royal
Brompton Hospital, London, Greater London, United Kingdom, SW3 6NP,4National Heart and Lung Institute, Imperial College
London, London, Greater London, United Kingdom, SW7 2AZ,5 School of Pharmacy, The University of Auckland,
Auckland, New Zealand.
Corresponding author: Christina Joanne Pearce, UCL School of
Pharmacy, Research department of Practice and Policy, BMA/Tavistock
House, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9JP,
United Kingdom. Email: christina.pearce.15@ucl.ac.uk
Take home message: Interventions to increase adherence to ICS
can be effective in children with asthma, but more rigorous intervention
methods are needed. Patients’ beliefs about ICS and their ability to
adhere should be targeted in future patient-tailored interventions.
Key words: Adherence; diagnosis; asthma; intervention; inhaled
corticosteroids; systematic review
Abstract
Introduction: Non-adherence to inhaled corticosteroids (ICS) in children
with asthma leads to significant morbidity and mortality. Few
interventions to improve adherence have been effective and little is
known about what contributes to intervention effectiveness. This
systematic review summarises the efficacy of these interventions and the
characteristics of effective interventions to inform future studies
aiming to improve adherence to ICS in children with asthma.
Methods: PubMed, Embase, PsychINFO, Medline, Web of Science, and
International Pharmaceutical Abstracts were systematically searched on
the 3rd of October 2020 for randomised control trials
measuring adherence to ICS in children with asthma. A narrative
synthesis was conducted focusing on intervention efficacy and study
reliability. Intervention content was coded based on the NICE guidelines
for medicines adherence (The Perceptions and Practicalities Approach,
PAPA) and Behaviour Change Techniques (BCT), to determine the effective
aspects of the intervention.
Results: Of 240 studies identified, 25 were eligible for inclusion.
Thirteen of the twenty-five studies were categorised as being highly
reliable. Nine of the thirteen studies were effective at increasing
adherence and six of those met the criteria for a PAPA intervention.
Conclusion: Adherence interventions in children with asthma have mixed
effectiveness. Effective studies tended to be of higher quality, were
tailored to individuals perceptual and practical adherence barriers, and
used multiple BCTs. However, due to the small number of included studies
and varying study design quality, conclusions drawn here are
preliminary. Future research is needed to test a PAPA-based intervention
with a rigorous study design as outlined in this review.