PSYCHOLOGICAL FACTORS INFLUENCING TTHERAPEUTIC ADHERENCE IN ASTHMA

Abstract:

Asthma is a chronic disease that has been characterized in the last decades by a disparity between the technical possibilities of intervention and the comparative modest adherence to treatment. Among major factors influencing adherence, psychological factors can play a critical role, as they influence attitudes in all phases of the disease, before, within and after the contact to medical institutions and professionals. This study explores some of the psychological factors influencing adherence in asthma in Romanian population. The sample included n = 164 patients, suffering of asthma of at least 3 months and satisfying a number of inclusion criteria (age between 18 and 70, medium education and being subjects of first treatment for asthma). Research instruments included a standardized 40-items questionnaire designed for evaluating adherence, HAD questionnaire and clinical interview. Results showed that self-assumed adherence proved to be higher than the actual one (79,87% vs. 59,75%), with most patients not aware of their problems in accurately respecting the physician's indications. Generally, patients, irrespective of their actual adherence, overestimate their possibilities of fulfilling physician's prescriptions. There is a significant percentage (more than 60,37%) of patients that lack important information about their disease (possible side effects, dangers of overdosing medication). 105 patients (64.02%) remarked a change in their family attitudes, after the onset of the disease, however these changes weren't associated to adherence levels. There is some flexibility and openness, regarding the preference for certain forms of medication (inhalers), but this is not associated to predisposition for higher or lower adherence. The relational skills of the physicians are valorized higher than their technical abilities (91,46% vs. 71,95%, respectively), and this perception is met both for adherent and non-adherent patients, emphasizing the importance of developing communicational skills of professionals involved in asthma treatment. Anxiety and depression co-occur in non-adherent asthmatic patients, yet the direction of the relation between non-adherence and anxiety or depression is still to be established. The study concludes on the necessity of more care dedicated to the subjective factors able to influence adherence, such as knowledge of side effects and overdose risks, family environment, benefits and risks of paternalistic attitudes, anxiety and depression, with a real and functional individualization of therapeutic programs dedicated to management of asthma.

Keywords: asthma, adherence, psychological intervention