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  5. CFHealthHub: Supporting people with Cystic Fibrosis (CF) to increase adherence to nebuliser treatment

CFHealthHub: Supporting people with Cystic Fibrosis (CF) to increase adherence to nebuliser treatment

Cystic fibrosis (CF) is a genetic condition that causes thick sticky mucus to build up in the lungs. This makes people susceptible to infections which can cause lung damage over time.

Treatments for cystic fibrosis are effective in reducing the amount of mucus and treating and preventing infections. However, in common with many other long-term health conditions, adherence to medication in people with cystic fibrosis is low. Objective measures indicate that only 36% of prescribed nebuliser treatments are taken.

We are working to develop theory and evidence based interventions to help people to adhere to their treatments so that they can remain fit and healthy for as long as possible.

CFHealthHub – what we do

CFHealthHub is a research programme, funded by National Institute for Health Research (NIHR) to develop and evaluate an intervention to support Adherence to treatment in adults with Cystic Fibrosis.

The programme, which commenced in March 2015, is led by a team from Sheffield Teaching Hospitals, the University of Sheffield, Sheffield Hallam University, the University of Manchester, and Queens University Belfast.

Madelynne Arden, Professor of Health Psychology and Director of the Centre for Behavioural Science and Applied Psychology at Sheffield Hallam University, has led the development of the behaviour change intervention within the CFHealthHub programme which has involved a number of steps:

  1. Identifying the barriers and facilitators to nebuliser adherence in adults with cystic fibrosis using the Theoretical Domains Framework.
  2. Systematically developing a prototype intervention to address the barriers to adherence using the Behaviour Change Wheel approach
  3. Working with people with CF and clinicians to develop and refine the intervention so that it meets their needs using a person-based approach.
  4. Training health professionals to deliver the intervention, and assessing the fidelity of that delivery.

The intervention was tested in a pilot trial and is currently being delivered as part of a randomised controlled trial across 19 UK sites. The intervention is also being used within a 'data observatory' where it is being delivered as part of CF clinical care in 3 UK sites.

To find out more watch our video.

Some of the research so far

Hoo, Z. H., Gardner, B., Arden, M. A., Waterhouse, S., Walters, S. J., Campbell, M. J., ... & Wildman, M. J. (2018). Role of habit in treatment adherence among adults with cystic fibrosis. Thorax, thoraxjnl-2017. https://thorax.bmj.com/content/early/2018/06/09/thoraxjnl-2017-211453

Arden, M. A., Hutchings, M., Nightingale, J. A., Allenby, M., Dewar, J., Oliver, C., ... & Wildman, M. (2017). IPD2. 08 CFHealthHub: understanding psychosocial differences between high, medium and low adherers to nebuliser treatment: An exploratory analysis of data from CFHealthHub two centre pilot trial. Journal of Cystic Fibrosis, 16, S60. https://www.cysticfibrosisjournal.com/article/S1569-1993(17)30358-2/abstract

Arden, M. A., Drabble, S. J., O'Cathain, A., Hutchings, M., & Wildman, M. (2016). Understanding adherence to nebuliser treatment in adults with cystic fibrosis using the Theoretical Domains Framework. In Journal of Cystic Fibrosis (Vol. 15, No. Supplement 1, p. S26). Elsevier. https://www.cysticfibrosisjournal.com/article/S1569-1993(16)30151-5/abstract

Daniels T, Goodacre L, Sutton C, Pollard K, Conway S, & Peckham D. (2011) Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers. Chest 140(2):425-32.

Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation science, 7(1), 37.

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 42.

Yardley, L., Morrison, L., Bradbury, K., & Muller, I. (2015). The person-based approach to intervention development: application to digital health-related behavior change interventions. Journal of medical Internet research, 17(1).

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