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

Abstract

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