Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, NC.
Duke Asthma, Allergy & Airway Center, Durham, NC.
J Allergy Clin Immunol Pract. 2021 Jan;9(1):410-418.e4. doi: 10.1016/j.jaip.2020.08.021. Epub 2020 Aug 26.
Internationally, adult asthma medication adherence rates are low. Studies characterizing variations in barriers by country are lacking.
To conduct a scoping review to characterize international variations in barriers to asthma medication adherence among adults.
MEDLINE, EMBASE, Web of Science (WOS), and CINAHL were searched from inception to February 2017. English-language studies employing qualitative methods (eg, focus groups, interviews) were selected to assess adult patient- and/or caregiver-reported barriers to asthma medication adherence. Two investigators independently identified, extracted data, and collected study characteristics, methodologic approach, and barriers. Barriers were mapped using the Theoretical Domains Framework and findings categorized according to participants' country of residence, countries' gross national income, and the presence of universal health care (World Health Organization definitions).
Among 2942 unique abstracts, we reviewed 809 full texts. Among these, we identified 47 studies, conducted in 12 countries, meeting eligibility. Studies included a total of 2614 subjects, predominately female (67%), with the mean age of 19.1 to 70 years. Most commonly reported barriers were beliefs about consequences (eg, medications not needed for asthma control, N = 29, 61.7%) and knowledge (eg, not knowing when to take medication, N = 27, 57.4%); least common was goals (eg, asthma not a priority, N = 1, 2.1%). In 27 studies conducted in countries classified as high income (HIC) with universal health care (UHC), the most reported barrier was participants' beliefs about consequences (N = 17, 63.3%). However, environmental context and resources (N = 12, 66.7%) were more common in HIC without UHC.
International adherence barriers are diverse and may vary with a country's sociopolitical context. Future adherence interventions should account for trends.
在国际上，成人哮喘药物治疗的依从性较低。缺乏按国家划分的障碍特征研究。
开展范围综述，以描述成年人哮喘药物治疗依从性障碍的国际差异。
从建库到 2017 年 2 月，检索 MEDLINE、EMBASE、Web of Science(WOS) 和 CINAHL 数据库。选择采用定性方法（例如，焦点小组、访谈）的英语研究，以评估成人患者和/或照料者报告的哮喘药物治疗依从性障碍。两名研究者独立识别、提取数据并收集研究特征、方法学方法和障碍。使用理论领域框架对障碍进行映射，并根据参与者的居住国家、国家的国民总收入以及全民健康覆盖的存在（世界卫生组织的定义）对研究结果进行分类。
在 2942 篇独特的摘要中，我们复习了 809 篇全文。在这些研究中，我们确定了 47 项研究，这些研究分别在 12 个国家进行，符合入选标准。这些研究共纳入 2614 名受试者，主要为女性（67%），平均年龄为 19.1 至 70 岁。最常报告的障碍是对后果的信念（例如，不需要药物控制哮喘，N=29，61.7%）和知识（例如，不知道何时服药，N=27，57.4%）；最不常见的是目标（例如，哮喘不是优先事项，N=1，2.1%）。在 27 项在高收入国家（HIC）进行的研究中，这些国家有全民健康覆盖（UHC），最常报告的障碍是参与者对后果的信念（N=17，63.3%）。然而，在没有 UHC 的 HIC 中，环境背景和资源（N=12，66.7%）更为常见。
国际上的依从性障碍多种多样，可能因国家的社会政治背景而异。未来的依从性干预措施应考虑到这些趋势。
