Effects of self-management interventions with behavior-change support on long-term adherence in patients with chronic...

The aim of this systematic review is to determine the effects of self-management interventions with behavior-change support on medication adherence and smoking cessation in patients with chronic respiratory disease. We also describe the theories of health behavior change and behavior change techniques (BCTs) used to design these interventions and their mode of delivery. The PubMed/MEDLINE, Cochrane Library, CINAHL, and Pedro databases were systematically searched for relevant articles published up to November 2021. Randomized controlled trials (RCTs) that evaluated the effect of self-management interventions with behavior change support on medication adherence, correct inhaler use, and smoking cessation were included. Effect sizes (odds ratios) with 95% confidence intervals were calculated and pooled for random-effect meta-analysis. Of 5,223 articles identified, 15 were RCTs that met the inclusion criteria for the meta-analysis. Five of these RCTs were based on behavior change theory, including social cognitive theory and a transtheoretical model. Between one and eight components of BCTs in Behavior Change Technique (BCT) Taxonomy version1 were included in all interventions. The most frequent BCT components were social support (emotional) (n = 8), instruction on how to perform the behavior (n = 8), and goal setting (behavior) (n = 7). Meta-analysis showed that self-management interventions with behavior change support have positive effects on medication adherence, correct inhaler use, and smoking cessation for more than 6 months after their implementation. This indicates that individually tailored self-management interventions with behavior change support are effective in improving long-term medication adherence and smoking cessation in patients with chronic respiratory disease.