Improving Adrenaline Autoinjector Adherence: a Psychologically-informed Training for Healthcare Professionals

Background: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline auto-injectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use auto-injectors. Health Psychology principles suggest exploring these factors with patients could improve their auto-injector use. Objective: To evaluate the impact of a 90 - minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to auto-injector use with patients. Attendees’ knowledge, confidence and likelihood of using the strategies were expected to improve. Methods: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence and likelihood of using the strategies taught were evaluated online one week before, 1–3 and 6–8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. Results: Chi-square analyses were significant in most cases (p <.05), with sustained (6–8 weeks) improvements in knowledge, confidence and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees’ knowledge of the care pathway, understanding of patient’s experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. Conclusion: Training clinicians in psychologically- informed strategies produce sustained improvements in their confidence and knowledge around patient auto-injector education, and their likelihood of using strategies in clinical practice. Clinical Relevance: Exploring psychological barriers should be part of training patients with anaphylaxis in auto - injector use

Nonadherence to Carrying and Using Adrenaline Pens in Adults With Anaphylaxis: The Impact of a Psychologically Informed Training Intervention on Staff Knowledge and Beliefs

Objectives: Nonadherence to carrying adrenaline pens and using them appropriately are problematic in anaphylaxis patients and associated with increased fatalities. This study evaluated the impact of a staff training intervention designed to enhance patient adherence. The health psychology informed intervention was predicted to produce sustained improvements in staff knowledge, confidence and intention to use adherence focused strategies with patients. Method: A longitudinal mixed method design was used to evaluate the training impact. Thirty one health professionals (general and specialist nurses, GPs, pharmacists) working with anaphylaxis patients in UK hospitals and general practice attended a 90 minute workshop training staff in psychologically informed strategies to enhance patient adherence. Attendees completed an online survey measuring their knowledge, confidence and intention to use adherence enhancing strategies one week before, and 1-3 and 6–8 weeks after the workshop. Staff were also invited to complete a telephone interview after attending to explore further the workshop impact. Results: Chi ‐ square goodness of fit tests were significant in most cases (P <.05). The workshop produced sustained (6 – 8 weeks)improvements in staff knowledge, confidence and intention to use strategies enhancing patient adherence. Staff certainty about the clinical importance of adherence also increased. Thematic analysis of the qualitative interview data identified four themes: •Altered understanding of anaphylaxis patients' experiences from primarily physical to also psychological • Changed staff communication with other patient groups • Contextual barriers impeded use of adherence enhancing strategies with patients • Conflict around 'risks’ when promoting adherence amongst anaphylaxis patients Conclusions: Although a small study, the workshops had positive impacts on attendees’ ability and willingness to address patients’ nonadherence, and understanding of the complex psychological factors associated with patient adherence. Self- reported benefits to clinical practice with other patient groups suggest psychologically underpinned interventions do impact on staff behaviour within clinical practice