Reframing asthma and inhaled corticosteroids (ICS) to modify treatment beliefs: an online randomised controlled trial

Abstract

ICS nonadherence contributes to poor asthma control. Perceptions of asthma and ICS are important determinants, particularly doubts about ICS-necessity (N) and concerns (C) about harm. Our intervention, the Balance Model (BM), communicates a common-sense rationale for ICS-N and addresses C using health psychology theory. We examined its effect on ICS-beliefs and adherence in people without asthma (asthma-naive, a proxy for newly-diagnosed patients) and with asthma. We randomised 503 adults reporting asthma and 388 asthma-naive to: Control (NHS-information) vs BM-text vs BM-video. N-C medication beliefs, adherence and intentions were assessed post-intervention and follow-up (2wk). Asthma-naive: BM-video participants reported higher N (F(2,252)=7.1, p=.001) and lower C (F(2,252)=9.6, p Asthma: Medication beliefs group differences were non-significant, but N increased in BM-video participants post intervention (t(150)=-2.54, p=0.012) and follow-up. In the BM-text group C decreased (t(151)=2.19, p=0.029) post intervention only. The BM-text group reported higher adherence at follow-up than controls (t(230)=-2.42, p=0.016). The BM, especially as a video, could help newly-diagnosed people develop a medically accurate, common-sense understanding of asthma and ICS motivating adherence. In the asthma group the BM changed ICS-beliefs and reported adherence but the effects were smaller, equivalent to NHS-information, likely due to fixed beliefs based on experience, requiring more intensive, personalised approaches.