Assessing Patient Adherence to Asthma Inhaler Therapy in Community Pharmacies

Thesis Abstract

Asthma remains a significant public health concern globally, with suboptimal inhaler adherence identified as a critical barrier to achieving effective disease control and reducing exacerbations. Despite the availability of effective inhaler therapies, many patients fail to follow prescribed regimens consistently, leading to increased morbidity, healthcare utilization, and economic burden. This study aims to evaluate the level of patient adherence to inhaler therapy among asthma patients attending community pharmacies and to identify the determinants influencing adherence behaviors. The specific objectives are to measure adherence rates using validated tools, explore patients’ perceptions and beliefs regarding inhaler use, and assess the role of community pharmacist interventions in promoting adherence. A cross-sectional descriptive design was employed, adopting a mixed-method approach to provide a comprehensive understanding of adherence patterns and underlying factors. The study was conducted in urban community pharmacy settings within the metropolitan region, targeting adult asthma patients aged 18 years and above who have been on inhaler therapy for at least six months. A sample size of 400 participants was calculated based on Cochran’s formula to ensure statistical power, employing stratified random sampling to capture diverse demographic and socioeconomic backgrounds. Data collection instruments included a structured questionnaire incorporating the Morisky Medication Adherence Scale (MMAS-8), a beliefs about medicines questionnaire grounded in the Theory of Planned Behavior, and semi-structured interview guides for qualitative insights. Quantitative data were analyzed using SPSS (version 26), employing descriptive statistics to determine adherence levels, and inferential techniques such as multiple regression analysis to examine predictors of adherence, including demographic variables, medication beliefs, and pharmacist-patient interactions. Qualitative data from interviews were subjected to thematic analysis utilizing NVivo software, leading to the identification of recurring themes related to patient motivations and barriers to inhaler adherence. The study integrates the Health Belief Model (HBM) and the Theory of Reasoned Action to interpret the behavioral determinants influencing adherence behaviors. Expected findings suggest that approximately 55% of participants exhibit high adherence levels, while 30% demonstrate moderate, and 15% low adherence. Key factors associated with better adherence are positive medication beliefs, effective counseling by pharmacists, and prior experience of symptom relief. Conversely, common barriers include forgetfulness, concerns about inhaler side effects, and perceived complexity of regimen. The study anticipates revealing a significant association between pharmacist-led education and improved adherence, highlighting the vital role community pharmacies play in chronic disease management. This research contributes to the existing body of knowledge by providing empirically grounded insights into adherence dynamics in the context of community pharmacy practice within a developing country setting. It emphasizes the importance of targeted interventions, such as patient counseling and tailored health education, grounded in behavioral theories, to enhance adherence. The findings are expected to inform policymakers and pharmacy professionals on designing sustainable strategies to improve inhaler use, ultimately aiding in asthma control and reducing healthcare costs. In conclusion, the study underscores the multifaceted nature of medication adherence and advocates for integrated approaches combining behavioral insights and pharmacist engagement. Recommendations include developing standardized counseling protocols, implementing reminder systems, and fostering collaborative healthcare models to optimize inhaler adherence. Future research should explore longitudinal designs to assess the impact of such interventions over time and examine their scalability across different regions and healthcare settings.