Visser Claire D, Linthorst Jip M, Kuipers Esther, Sont Jacob K, Lacroix Joyca P W, Guchelaar Henk-Jan, Teichert Martina
Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands.
Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands.
Front Pharmacol. 2021 Dec 22;12:767092. doi: 10.3389/fphar.2021.767092. eCollection 2021.
Suboptimal self-management of inhaled corticosteroids (ICS) in asthma patients is frequently observed in clinical practice and associated with poor asthma control. Driving factors for suboptimal self-management are complex and consist of a range of behavioral barriers (cognitive, affective and practical) with a considerable inter-individual variability. Identification of individual barriers facilitates the use of corresponding behavior change techniques and tailored care to improve asthma treatment outcomes. This study describes the development and validation of the 'Respiratory Adherence Care Enhancer' (RACE) questionnaire to identify individual barriers to self-management of ICS therapy in asthma patients. The development included: 1) an inventory of self-management barriers based on a literature review, 2) expert assessment on relevance and completeness of this set, linking these barriers to behavioral domains of the Theoretical Domains Framework (TDF) and 3) the formulation of corresponding questions assessing each of the barriers. A cross-sectional study was performed for validation. Primary care asthma patients were invited to fill out the RACE-questionnaire prior to a semi-structured telephonic interview as golden standard. Barriers detected from the questionnaire were compared to those mentioned in the interview. The developed questionnaire is made up of 6 TDF-domains, covering 10 self-management barriers with 23 questions. For the validation 64 patients completed the questionnaire, of whom 61 patients were interviewed. Cronbach's alpha for the consistency of questions within the barriers ranged from 0.58 to 0.90. Optimal cut-off values for the presence of barriers were determined at a specificity between 67 and 92% with a sensitivity between 41 and 83%. Significant Areas Under the Receiver Operating Curves values were observed for 9 barriers with values between 0.69 and 0.86 (-value <0.05), except for 'Knowledge of ICS medication' with an insignificant value of 0.53. The RACE-questionnaire yields adequate psychometric characteristics to identify individual barriers to self-management of ICS therapy in asthma patients, facilitating tailored care.
在临床实践中，经常观察到哮喘患者对吸入性糖皮质激素（ICS）的自我管理欠佳，且这与哮喘控制不佳有关。自我管理欠佳的驱动因素很复杂，包括一系列行为障碍（认知、情感和实际方面），个体间差异很大。识别个体障碍有助于使用相应的行为改变技巧和量身定制的护理措施，以改善哮喘治疗效果。本研究描述了“呼吸依从性护理增强器”（RACE）问卷的开发和验证过程，该问卷用于识别哮喘患者ICS治疗自我管理的个体障碍。开发过程包括：1）基于文献综述列出自我管理障碍清单；2）专家对该清单的相关性和完整性进行评估，将这些障碍与理论领域框架（TDF）的行为领域联系起来；3）制定评估每个障碍的相应问题。进行了一项横断面研究以进行验证。邀请基层医疗中的哮喘患者在半结构化电话访谈之前填写RACE问卷，将其作为金标准。将问卷中检测到的障碍与访谈中提到的障碍进行比较。所开发的问卷由6个TDF领域组成，涵盖10个自我管理障碍，共23个问题。为进行验证，64名患者完成了问卷，其中61名患者接受了访谈。障碍内问题一致性的Cronbach's α系数范围为0.58至0.90。障碍存在的最佳截断值确定为特异性在67%至92%之间，敏感性在41%至83%之间。观察到9个障碍的受试者工作特征曲线下面积值显著，范围在0.69至0.86之间（P值<0.05），“对ICS药物的了解”除外，其值为0.53，无统计学意义。RACE问卷具有足够的心理测量学特征，可识别哮喘患者ICS治疗自我管理的个体障碍，有助于提供量身定制的护理。
