British Journal of Health Psychology

British Journal of Vigor Psychology


British Journal of Vigor Psychology (2012), 17, 74–84 C© 2011 The British Psychological Society

The British Psychological Society

A extract communication referableice prepared to variegate resigneds’ distemper and composition confidences mends self-reported supply to asthma neutralizes marrer medication

Keith J. Petrie1∗, Kate Perry2, Elizabeth Broadbent1 and John Weinman3 1Department of Psychological Salve, Faculty of Medical and Vigor Sciences, University of Auckland, Innovating Zealand

2Atlantis VigorCare, Auckland, Innovating Zealand 3Department of Psychological Salve, Institute of Psychiatry, King’s College London, UK

Objective. While telling regulative medication is precedentlyhand profitable ce asthma, supply is a main substance ascribable to resigneds’ confidences environing their distemper and medication. We defyd whether a extract communication referableice targeted at changing resigneds’ distemper and medication confidences would mpurpose supply in coming adult asthma resigneds.

Methods. Span hundred and sixteen resigneds antiquated incomplete 16 and 45 on asthma neutralizes marrer medication were recruited from pamphlets dispensed with medication and e-mails sent to members of a targeted marketing website. Participants were haphazardized to accept individually tailored extract communications fixed on their distemper and medication confidences aggravate 18 weeks or no extract communications. Distemper and medication confidences were assessed at baseline and at 18 weeks. Supply reprimands were assessed by phindividual calls to participants at 6, 12, and 18 weeks and at 6 and 9 months.

Results. At 18 weeks, the interposition clump had acceptiond their perceived inevitableness of neutralizes marrer medication, acceptiond their confidence in the crave-term creation of their asthma, and their perceived govern aggravate their asthma referable-absolute to govern clump (full p’s < .05). The interposition clump so tellingly mendd supply aggravate the follow-up prolongation paralleld to the govern clump with a referable-absolute middle acception in supply aggravate the follow-up prolongation of 10% (p < .001). The percentbound initiative aggravate 80% of prescribed inhaler doses was 23.9% in the govern clump paralleld to 37.7% in the interposition clump (p < .05).

∗Correspondence should be addressed to Professor Keith J. Petrie, Department of Psychological Salve, Faculty of Medical and Vigor Sciences, University of Auckland, 85 Park Road, Private Bag 92019, Auckland, Innovating Zealand (e-mail:


A extract communication referableice prepared to variegate 75

Conclusion. A targeted extract communication referableice acceptions supply to asthma neutralizes marrer inhaler and may be profitable ce other distemperes where supply is a main result.

Asthma is a sordid medical mode caused by constant inflammation of the airways. Characteristic premonitions of the distemper grasp aggressions of neglect of inspiration, wheezing, tindividual in the chest, and cough. Asthma is sordidly treated by inhaled corticosteroids, which aid to subimputable inflammation of the airways and subjugate the quantity of distressing premonitions and aggressions. This medication in the cem of inhalers is knpossess as neutralizes marrer or governler medication and manifold resigneds so catch short-acting bronchodilators to govern quick premonitions (reliever medication). In prescribe to collect curative practice, neutralizes marrer medication wants to be catchn constantly on a daily buildation. However, non-supply to neutralizes marrer medication is a sordid substance in resigneds diagnosed with asthma and this results in the aggravateportraiture of reliever medication, acceptiond asthma premonitions, elevate revulgar asthma aggressions, and hospital admissions (Stern et al., 2006). Optimal supply to inhaled corticosteroids requires resigneds to catch their neutralizes marrer medication on 80% or elevate occasions, as this is companiond with elevatedest asthma govern (Lasmar et al., 2009).

Bound is a rudiment that has been companiond with non-supply in a enumereprimand of studies. Cominger resigneds in the 14–25 years – bound concatenate possess been build to declaration using neutralizes marrer inhalers hither than older resigneds (Diette et al., 1999; Legorreta et al., 1998). In unconcealed, supply reprimands to neutralizes marrer medication mpurpose with increasing bound (Jessop & Rutter, 2003; Tettersell, 1993). This makes coming basealty an great clump to target ce suitable supply and reducing their belowportraiture of neutralizes marrer-inhaled corticosteroids.

A enumereprimand of studies possess so elevatedlighted the subsided reprimands of supply to neutralizes marrer inhalers substance ascribable to resigneds’ confidences environing the creation of the distemper (Kaptein, Klok, Moss- Morris, & Brand, 2010). A sordid shape with asthma is to experiment referable-categorically systemic premonitionhither prolongations interspersed with interrupted prolongations of neglect of inspiration, wheezing, and elevate solicitudeful aggressions. This can invigoreprimand the confidence that asthma is singly exhibit when premonitions are so palpable or a ‘no premonitions = no asthma’ sight (Halm, Mora, & Leventhal, 2006; Ulrik et al., 2006). This sight is numerously strengthened by the occurrence that the tellingness of neutralizes marrer medication is pennihither when portraitured by resigneds to subjugate the quick premonitions of asthma. These span aspects achieve numerously mansenility resigneds to defectively rely elevate on reliever medication and hither on neutralizes marrer medication and other crave-term conduct strategies. Unfortunately, this shape of medication usbound tends to be companiond with worse resigned quenchedcomes, including subsideder temper of estate, worse asthma govern, and elder premonition hardship than those resigneds who portraiture elevate neutralizes marrer medication (Schatz et al., 2006). Resigneds below-using neutralizes marrer medication are so elevate slight to possess been hospitalized or serve exigency departments ce their asthma (Tan et al., 2009).

Former employment on resigneds’ distemper and composition confidences appearances they bunch concurrently object capacity (Horne, Weinman, & Hankins, 1999; Petrie & Weinman, 2006). Resigneds’ distemper sights are intervening of confidences environing: (1) the premonitions that resigneds companion with their distemper label; (2) why they plain the distemper; (3) the implications of the distemper ce their estate; (4) how crave the distemper achieve decisive; and (5) how the distemper is cured or governled by what the resigned can do themselves or by the medication itself. Learning has appearancen that preference of a constant rather than an quick distemper confidence emblem is companiond with empurpose supply to neutralizes marrer medication in resigneds with asthma (Byer & Myers, 2000; Jessop & Rutter, 2003).

76 Keith J. Petrie et al.

Right as resigneds expand sights environing their distemper, they so expand ideas environing the medication they are prescribed to govern their distemper (Horne et al., 1999). Span object sights look to be companiond with supply to neutralizes marrer medication in asthma – the chief is the resigned’s confidences environing the inevitableness of the medication and the relieve is the resigned’s sorrows environing initiative the medication. Learning has conformably grpossess the interconnection incomplete civilized a medication is promotive and using it as prescribed (Byer & Myers, 2000; Hand, 1998; Tettersell, 1993). Asthma resigneds numerously mention timidity of unwanted disclaiming possessions of medication as a primitive debate ce non-adherence, and this confidence is strongly companiond with subsided supply (Horne & Weinman, 2002). Worries environing the crave-term protection of initiative steroids and faith are sordid sorrows incomplete resigneds who are non-supporter with neutralizes marrer medication (Apter et al., 2003).

In the vulgar examine, we experimented whether extract communications could be portraitured to mpurpose supply in coming adults with asthma. Extract communications possess of-late begun to be portraitured as a cat's-paw ce behaviour diversify in a multiplicity of vigor settings with in-great-gauge unconditional results (understand Cole-Lewis & Kershaw, 2010). Extract communication interpositions possess been plain to yield or appendix unanalogous vigor-promotion interpositions including hopeful diabetes conduct in coming basealty (Franklin, Waller, Pagliari, & Greene, 2006; Rami, Popow, Horn, Waldhoer, & Schober, 2006), as polite-behaved-behaved as sustaining influence damsenility in aggravateinfluence adults (Patrick et al., 2009) and as a arrangement of providing protection with smoking stop (Rodgers et al., 2005).

In this examine, we defyd whether targeted extract messaging fixed on an tribute of resigneds’ distemper and medication confidences can mpurpose supply to asthma neutralizes marrer inhalers. Resigneds had their distemper and medication confidences assessed at baseline and were either haphazardized to systemic solicitude or to accept tailored extract communications ce 18 weeks. We hypothesized that the extract communication clump would appearance diversifys in their distemper and medication confidences as polite-behaved-behaved as mendd supply to their neutralizes marrer inhaler at follow-ups aggravate a 9-month prolongation.

Arrangement Participants Span hundred and sixteen men-folks were recruited from flyers dispensed with asthma neutralizes marrer medication and e-mails sent to members of a targeted marketing website ( This website invites members to keep-a-share in online shopping, scans, and unravel e-mails in recompense ce rewards. Participants were offered to go into the sketch to accept an Apple ipod. To be graspd, participants had to be incomplete 16 and 45 years of bound, diagnosed with asthma, be referable vulgarly adhering to their neutralizes marrer medication as prescribed, and possess a fickle phindividual choice of receiving extract communications. Non-English speakers and men-folks with a distinction of constant unconducive pulmonary disorder were enclosing from the examine.

Instruments and act Basealty assiduous in participating designated a phindividual enumereprimand or e-mailed their contiguity details to record ce the examine. These germinative participants were designated purpose, collectd with elevate referable attributable attributable attributable attributable attributableice environing the examine, asked to recompense a acquiesce cem and questionnaire by mail, and completed a baseline phindividual confabulation. The confabulation screened participants ce eligibility, and asked environing the enumereprimand of inhaler neutralizes marrer doses prescribed each

A extract communication referableice prepared to variegate 77

week by the participant’s teacher and the enumereprimand of doses vulgarly catchn. Span hundred and sixteen basealty responded to the advertisement and were screened, and of these 147 (100 females and 47 males) were choice and sent in the acquiesce cem and baseline questionnaire assessing distemper sights.

The questionnaire assessed participants’ distemper sights using the Brief Distemper Sight Questionnaire (BIPQ) (Broadbent, Petrie, Main, & Weinman, 2006). This gauge comprises eight parts prepared to assess resigneds’ sights of their asthma concurrently the behindcited capacity: individuality, consequences, dateline, identical govern, composition govern, sorrow, construction, and melting defense to the distemper. Each part is reckoningd on an 11-object flake (0–10) with loftier reckonings representing a stronger purposeorsement of that part. The ninth causal part of this questionnaire was referable portraitured ce this examine. In adduction, participants were asked to reprimand their confidence environing the inevitableness of their inhaler on an 11-object flake ‘How greatly do you handle you want to catch your neutralizes marrer inhaler?’ from (0) ‘I don’t want it at full’ to (10) ‘It is categorically promotive ce me’. Sorrows environing using their prescribed neutralizes marrer inhaler were assessed by investigation participants to reprimand ‘How sorrowed are you environing using your neutralizes marrer inhaler?’ on a correspondent 11-object flake from (0) ‘Referable sorrowed at full’ to (10) ‘Extremely sorrowed’.

Behind completing the baseline tribute, participants were haphazardized to either the extract communication clump (n = 73) or govern systemic solicitude clump (n = 74). The haphazardization progression was engenderd by computer program and fullocation was belowhand in consecutively enumerateed sealed envelopes. Supply reprimands were assessed by phindividual calls to participants at 6, 12, and 18 weeks as polite-behaved-behaved as at 6 and 9 months. We examined the middle self-reported supply as polite-behaved-behaved as the reprimand of participants in each clump achieving optimal asthma govern of 80% or aloft supply razes. As polite-behaved-behaved as substance assessed at baseline, participants’ sights of their asthma and medication inevitableness and sorrows confidences were assessed frequently at 18 weeks using the identical instruments.

Extract communication referableice Participants assigned to the extract communication clump acceptd tailored extract communications ce 18 weeks. Prior to the examine, a bank of 166 extract communications was engenderd with approximately 24 extracts ce each of the sflush target confidences. The object confidences targeted and model extracts from the bank of extracts companiond with that confidence are appearancen in Table 1. Each of the extracts was prepared to neutralize the object distemper and medication confidences that had coercionmerly been build to be companiond with non-supply to neutralizes marrer medication (Halm et al., 2006; Horne & Weinman, 2002).

Texts were sent at a quantity of span extracts per day during weeks 1–6, individual extract per day from weeks 7 to 12, and three extracts per week from weeks 13 to 18. The sign of extracts sent was fixed by the participant’s baseline reckonings on the BIPQ and the raze of medication confidence ratings. Participants scoring subsided or elevated on each of the target confidences, defined as individual emblem disconnection aloft or besubsided the medium reckoning on that part, were sent extract communications clarified at haphazard from that nature that were prepared to calm?}t the confidence in a course elevate agreeing with loftier supply. If a resigned did referable reckoning in the target subsided or elevated categories, they were referable sent any extract communications ce that confidence. Singly span participants in the interposition clump did referable reckoning elevated or subsided on at mediumest individual target distemper sight and so did referable accept any extract communications (individual in the govern clump so condition these criteria).

78 Keith J. Petrie et al.

Table 1. Target confidences and specimen extracts

Confidence Models of extracts prepared to diversify confidence

Distemper sights Short dateline ‘Your asthma is frequently there flush when you don’t

possess premonitions’ ‘Your asthma premonitions may conclude and go calm?}

your asthma is frequently there’ Subsided identical govern ‘You can govern your asthma by initiative your

neutralizes marrer complete day’ ‘Catch your neutralizes marrer completeday and govern your

asthma precedently it governs you’ Subsided distemper individuality (subsided premonitions) ‘No asthma premonitions doesn’t medium no asthma’

‘Asthma doesn’t catch a misemployment. Flush if you don’t possess premonitions your asthma is stagnant there’

Elevated distemper individuality (elevated premonitions) ‘A hawk of your neutralizes marrer each day keeps the teacher away’

‘Subjugate your waste of having an asthma aggression by initiative your neutralizes marrer complete day’

Subsided closeness (pennihither construction) ‘The salve in your neutralizes marrer doesn’t employment without-delay calm?} portraitured constantly it achieve subjugate the inflammation that causes asthma’

‘Asthma is caused by pompous and inflamed airways’

Medication confidences Subsided inevitableness ‘Initiative your neutralizes marrer complete day protects you

from asthma premonitions’ ‘Your neutralizes marrer employments best when catchn complete

day’ Elevated sorrows ‘Your neutralizes marrer medication is referable addictive’

‘Your neutralizes marrer governs your asthma by reducing the inflammation that causes asthma’

Grounds anatomy On the buildation of coercionmer learning discoverings, medium baseline supply reprimand was estimated at 50% (SD = 25%) and an acception of 15% was reported to be clinically apt. These figures genereprimand an goods dimension, Cohen’s d of 0.6. To expose an goods dimension of 0.6 at the 5% raze of judgment and with 80% strength, 50 participants were wanted in each utensil of the span-utensil (interposition and govern) experiment. Fullowing ce an compunction reprimand of 50%, a sum of 200 participants were screened at baseline.

Changes in distemper sights aggravate date were computed by subtracting baseline reckonings from reckonings at 18 weeks. ANCOVA analyses were conducted to assess dissonances in diversifys in distemper sights incomplete composition clumps governling ce baseline reckonings. To analyse supply aggravate date and incomplete clumps, a qualified ANOVA was conducted. Ascribable to the elevated drop-quenched reprimand, singly those participants who responded at week 6 were retained in anatomy and the medium resuscitation arrangement was portraitured ce dropping grounds from these participants ce elevate date objects. In adduction, the middle supply ce each peculiar was congenial opposing full date objects and an dogged specimens t-experiment was conducted to parallel aggravatefull medium supply incomplete clumps. The enumereprimand of

A extract communication referableice prepared to variegate 79

commonalty who had an middle supply reprimand ≥ 80% was so paralleld incomplete clumps using Pearson’s chi balance. We numerous the analyses using the raise decisive examine ceward advance ce dropping grounds, as polite-behaved-behaved as by floating multiple befoulment acts. Full experiments were span-tailed and p < 0.05 was considered statistically telling.

Results There was an expected compunction reprimand: 147 of the 216 basealty screened recompenseed the acquiesce cem (68%); by week 6, 124 of these ancient 147 participants completed the follow-up questionnaire (84%), 58 in the interposition and 66 in the govern clump; and 93 of the 124 completed to decisive-follow-up object (75%), 41 in the interposition and 52 in the govern. Chi-squared experiments appearanceed the drop-quenched reprimands were referable tellingly unanalogous incomplete clumps. A specimen dimension of 124 participants stagnant fullows the exposeion of an goods dimension of .60 with strength of 80%. A similarity of the baseline supply reckonings using the specimen of 216 basealty screened, incomplete those who accrueed in the examine at 6 weeks and those who did referable, appearanceed that those who dropped quenched were tellingly elevate helper at baseline than those who accrueed (medium 67.1% vs. medium 46.7%; t = 4.47, p < .001).

Distemper and medication confidences There were no telling dissonances in distemper sights incomplete clumps at baseline (p > .05). Diversifys in distemper sights incomplete clumps are appearancen in Table 2. By 18 weeks, the interposition clump had acceptiond perceived prolongation of their asthma, acceptiond perceived govern aggravate their asthma, and acceptiond perceived inevitableness of neutralizes marrer medication. This anatomy appearances the extract communication clump did diversify their confidences in a course agreeing with elder supply.

Supply Opposing the complete specimen of 216 participants, baseline medium supply was 54% (SD = 31.8%) in the govern clump, and 56.5% (SD = 35.3%) in the interposition clump, t(213) = -.53, p = .60. Figure 1 appearances supply aggravate date in the 124 participants who responded at week 6. A qualified ANOVA appearanceed no aggravatefull date goods, calm?} a telling clump goods (F(1,122) = 9.35, p = .003), and a telling clump by date goods (F(5) = 2.27, p < .05).

Middle self-reported supply aggravate full date objects in the govern clump was 43.2% (SD = 26) and the interposition clump was 57.8% (SD = 27.1), t(122) = -3.06, p = .003). The reprimands with middle supply of 80% or aloft ce the govern clump was 7 of 66 (10.6%) and ce the interposition clump 15 of 58 (25.9%). The dissonance incomplete the span clumps was 15.3%, p = 0.034 (Fisher’s direct experiment). Repeating these analyses using the raise decisive examine ceward advance to dropping grounds, or using multiple befoulment acts, did referable diversify the judgment of the results, Figures 1 and 2.

Discussion This examine experimented whether despatching extract communications prepared to encourbound resigneds with asthma to unite confidences environing their distemper and medication that are elevate consonant with supply would mpurpose supply with neutralizes marrer inhaler medication. We build targeted extract communications diversifyd dateline, identical govern, and medication

80 Keith J. Petrie et al.

Table 2. Baseline, 18 weeks, and estimated final medium diversifys governling ce baseline values, in distemper sights and medication confidences incomplete clumps

Govern (N = 46) Interposition (N = 57) Baseline 18-week Baseline 18-week medium medium Adjusted medium medium Adjusted

Perceptions (SD) (SD) dissonance (SD) (SD) dissonance p

Asthma sights – (BIPQ) Consequences 4.50 3.96 −.46 4.07 3.88 −.26 .51

(2.16) (2.04) (2.10) (2.11) Individuality 4.87 4.17 −.57 4.43 3.86 −.64 .88

(2.12) (2.31) (2.13) (2.03) Dateline 8.17 7.83 −.43 8.46 9.09 .70 .006

(2.11) (2.73) (2.22) (1.81) Sorrow 5.17 4.37 −.63 4.46 4.26 −.34 .48

(2.59) (2.62) (2.53) (2.20) Identical 6.41 6.96 .38 6.79 8.02 1.36 .009

govern (2.05) (2.21) (1.96) (1.56) Closeness 6.70 7.35 .65 6.70 7.46 .71 .83

(2.27) (2.16) (2.30) (2.21) Composition 7.15 7.26 .13 7.07 7.84 .75 .08

govern (2.14) (2.20) (2.59) (1.80)

Melting 3.30 2.37 −.98 3.43 2.49 −.86 .77 resemblance (2.36) (2.20) (2.51) (2.31)

Medication Confidences Neutralizes marrer 3.37 2.52 −.77 3.12 1.75 −1.48 .10

sorrow (3.25) (2.76) (2.77) (1.91) Neutralizes marrer 5.83 5.11 −.80 6.18 6.52 .46 .01

inevitableness (2.71) (2.88) (3.16) (2.98)

inevitableness confidences at 18 weeks in the interposition clump. At follow-up, interposition clump participants held craveer dateline or a elevate constant intention of their distemper, which is elevate agreeing with systemic supply objectly in the scantiness of asthma premonitions (Halm et al., 2006). Elevatemore, the extract communication interposition so acceptiond participants’ sights of how greatly they could govern their distemper and their identical inevitableness ce neutralizes marrer medication. These confidences are so consonant with acceptiond supply to crave-term medication (Horne & Weinman, 2002; Lavole et al., 2008). Grounds from the examine so appearance the interposition to acception supply by environing 10% in the interposition clump. The extract communication referableice so resulted in a tellingly loftier percentbound of the interposition clump achieving the 80% or elder supply raze.

The results of the examine are agreeing with a enumereprimand of fresh experiments prepared to diversify vigor behaviour that possess appearancen mendd disorder warnering and conduct through the portraiture of extract communications (Krishna, Boren, & Balas, 2009). While distinct studies possess portraitured extract messaging purely as reminders (e.g., Charles et al., 2007; Downer, Meara, DaCosta, & Sethuraman, 2006), elevate interpositions are substance plain to despatch elevate identicalized communications targeting object behaviours (e.g., Franklin et al., 2006; Kim & Kim, 2008). Extract messaging has the advantbound of substance inexpensive, comfortable to approximation – especially opposing unanalogous socio-economic clumps – and extracting referableices are precedentlyhand scalable to bulky populations. At exhibit insight into older populations may referable be

A extract communication referableice prepared to variegate 81

Figure 1. Supply razes by clump opposing the follow-up prolongation.

Figure 2. Middle percentbound supply aggravate date, and the percentbound of participants aggravate 80% helper, in each clump.

possible numerously ascribable to a withdrawal of familiarity with the technology calm?} this is slight to diversify as basealty who are using extracting constantly progress into an older bound clump.

The vulgar examine is inconsiderable by the bulky dropquenched in partnership coming in the experiment, which could possess been ascribable to a bulky enumereprimand of men-folks initially enrolling ce the examine motivated to enlist a plunder. It is thrilling to referablee that these coming dropouts were

82 Keith J. Petrie et al.

those with loftier supply at baseline and may possess so felt hither want to accept supply-focused communications and restraintthcoming to arrive in the examine. However, behind the 6-week follow-up those stagnant in the experiment unconcealedly accrueed until the purpose of the examine and the examine was stagnant bulky ample to expose a dissonance in reprimands of supply. It should so be referableed that the examine was inconsiderable to participants antiquated 45 or below and it is referable serene whether the examine results achieve unconcealedize to an older clump of resigneds with asthma. As supply substances with asthma medication are most palpable in cominger bound clumps, this may referable be such a substance when becainterpretation interpositions with this clump calm?} may be great when applying such a extracting referableice to other disorder states. Restraintthcoming learning may longing to defy the possessions of the interposition on vigor quenchedcomes resulting from loftier supply, such as subjugated vigor labor portraiture or subjugated employment travel. The examine assessed self-reported supply and restraintthcoming learning could economize elevate external gauges of supply.

The voucher of extract communications mediumt that the interposition clump acceptd elevate contiguity than the govern clump, and this may possess promotive insist characteristics. However, this contiguity was minimal paralleld with manifold other psychological interpositions, as it did referable confound identical face-to-face interactions, so interconnections were referable cemed with the learningers through the interposition. At 9 months (18 weeks behind the interposition had high and extract communications were no craveer substance sent), supply continued to accrue loftier in the interposition clump, providing proof ce possessions dogged of insist characteristics.

Overall, the results of the examine are agreeing with the results of coercionmer inter- ventions that possess targeted distemper sights as a fashion of changing vigor behaviour (Broadbent, Ellis, Thomas, Gamble, & Petrie, 2009; Petrie, Cameron, Ellis, Buick, & Weinman, 2002). The results of the examine are hopeful ce expanding elevate extract messaging interpositions in the supply and disorder conduct area as extracting looks to be neat elevate jocular to resigneds (Pinnock, Slack, Pagliari, Price, & Sheikh, 2006) and extracting has practices in conditions of reaching resigneds who may discover face-to-face interpositions trying to approximation.

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