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Development and validation of the ‘Respiratory Adherence Care Enhancer’ (RACE) questionnaire, facilitating tailored care in asthma patients with inhaled corticosteroids.

  • At: PPR SIG 2021 (2021)
  • Type: Digital
  • By: VISSER, Claire (Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands., Netherlands)
  • Co-author(s): Claire D. Visser, Jip M. Linthorst, Esther Kuipers, Jacob K. Sont, Joyca Lacroix, Henk-Jan Guchelaar and Martina Teichert.
  • Abstract:


    Suboptimal self-management of inhaled corticosteroids (ICS) therapy in asthma patients is frequently observed in clinical practice and is associated with poor outcomes. Driving factors for suboptimal self-management are complex and consists of a range of barriers with a considerable inter-individual variability. Identification of individual barriers may enable tailored care to improve treatment outcomes.


    This study describes the development and validation of the ‘Respiratory Adherence Care Enhancer’ (RACE) questionnaire to identify individual self-management barriers of ICS therapy in asthma patients.


    The development comprised: 1) an inventory of potential self-management barriers based on a literature review which were then structured according to the Theoretical Domains Framework (TDF), 2) expert assessment on the relevance and completeness of the set of barriers and domains and 3) the formulation of corresponding questions assessing each of the barriers. Subsequently, a cross-sectional study was performed to validate the RACE-questionnaire. Primary care asthma patients were invited to fill out the RACE-questionnaire prior to a semi-structured telephonic interview which served as golden standard. Barriers detected from the questionnaire were compared to the barriers mentioned in the interview.


    The developed questionnaire included 6 TDF-domains covering 10 self-management barriers with 23 corresponding questions. For the validation 64 patients completed the questionnaire, of whom 61 patients completed the semi-structured interviews. Cronbach’s alpha for the internal consistency of 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 (AUROC) values were observed for 9 barriers with values between 0.69 and 0.86 (p-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 self-management barriers of ICS therapy in asthma patients, facilitating tailored care.

Last update 4 October 2019

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