Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 24, 2019
Date Accepted: Jun 25, 2020
Date Submitted to PubMed: Jul 22, 2020
Mechanisms of action of a web-based intervention with health professional support to increase nebulizer adherence in adults with Cystic Fibrosis: a qualitative interview study
ABSTRACT
Background:
Adherence to nebulizer treatments in adults with cystic fibrosis is often low. A new complex intervention to help adults with cystic fibrosis increase adherence to nebulizer treatments was piloted in two UK cystic fibrosis centres. Patients used a nebulizer with electronic monitoring capabilities that transferred data automatically to a digital platform (CFHealthHub) to monitor adherence over time and a tailored website to display graphs of adherence data and educational and problem solving information about adherence. A trained interventionist helped patients to identify ways to increase their adherence. Existing literature has identified three mechanisms of action important to telehealth interventions: relationships, visibility, and fit.
Objective:
We explore whether and how the telehealth mechanisms of action of relationships, visibility, and fit operated within a pilot randomized controlled trial of a new web-based intervention with health professional support to increase nebulizer adherence in adults with cystic fibrosis.
Methods:
A qualitative interview study undertaken concurrently with a pilot randomized controlled trial. Semi-structured interviews were conducted with three interventionists at two time points, 14 patients in the intervention arm and five members of the multidisciplinary team. A framework approach was used for analysis.
Results:
The mechanisms of relationships, visibility, and fit were evident in this intervention. Patients described the importance of building a relationship with the interventionist through face-to-face visits with someone who cared about them and their progress. Rather than seeing visibility of adherence to health professionals as problematic, patients found this motivating if they received praise about progress. The intervention was tailored to individuals but there were challenges in how the intervention fitted some patients’ needs, lives, and values.
Conclusions:
All three mechanisms associated with effective telehealth interventions operated within this new intervention. The intervention, modified based on these findings, is being tested in a randomized controlled trial of CFHealthHub in 19 UK cystic fibrosis centres. Clinical Trial: Trial registration: ISRCTN13076797
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