Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

M. A. Arden*, M. Hutchings, P. Whelan, S. J. Drabble, D. Beever, J. M. Bradley, D. Hind, J. Ainsworth, C. Maguire, H. Cantrill, A. O’Cathain, M. Wildman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden.


Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes.


Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs.


The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.
Original languageEnglish
Article number1
JournalPilot and Feasibility Studies
Publication statusPublished - 04 Jan 2021

Bibliographical note

Funding Information:
This study/project is funded by the National Institute for Health Research (NIHR) [ACtiF Programme (reference RP-PG-1212-20015)] Programme Grants for Applied Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Funding Information:
Martin Wildman received funding from Zambon and support from Philips Respironics for the early development work. This has not had any direct influence on the study reported here. Martin Wildman has worked with Pari to carry out studies using the eTrack. This has not had any direct influence on the study reported here. The University of Manchester software team received funding from Pari to create a medication reporting component within the CFHealthHub software. This has not had any direct influence on the study reported here.

Publisher Copyright:
© 2020, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


  • Adherence
  • Behaviour change wheel
  • Cystic fibrosis
  • Digital intervention
  • Habit formation
  • Intervention development
  • Person-based approach

ASJC Scopus subject areas

  • Medicine (miscellaneous)


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