Factors associated with inhaler therapy adherence using a multidimensional adherence model in patients with chronic obstructive pulmonary disease

ERBAY DALLI Ö., Bulut H., Bozkurt-Duman C.

Patient Education and Counseling, cilt.149, 2026 (SCI-Expanded, SSCI, Scopus) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 149
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1016/j.pec.2026.109646
  • Dergi Adı: Patient Education and Counseling
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, Abstracts in Social Gerontology, CINAHL, Educational research abstracts (ERA), EMBASE, Gender Studies Database, MEDLINE, Psycinfo, Public Affairs Index
  • Anahtar Kelimeler: Adherence, Associated factors, Chronic obstructive pulmonary disease, Inhaler therapy
  • Bursa Uludağ Üniversitesi Adresli: Evet

Özet

Objective: To investigate factors associated with adherence to inhaler therapy in patients with chronic obstructive pulmonary disease (COPD) by using the Multidimensional Adherence Model (MAM). Methods: The study was conducted with individuals hospitalized for COPD in a hospital for chest diseases. Data were collected across five dimensions based on the MAM framework (socio-economic, patient-related, condition-related, treatment-related, and healthcare system-related factors). The Test of Adherence to Inhalers was used to assess adherence; the Patient Health Questionnaire-9 and the COPD Self-Efficacy Scale were used to assess depression levels and self-efficacy, respectively, as part of patient-related factors. Results: Of the 300 patients with COPD in the study, 68.3% were non-adherent to inhaler therapy. Bivariate analysis showed significant differences between adherent and non-adherent groups regarding socio-economic (education, employment), patient-related (age, family support, depression, self-efficacy), condition-related (comorbidities, years with COPD, COPD stage, number of hospitalizations and emergency visits), and healthcare system-related factors (distance from home to hospital, receiving disease-related education) (p < 0.05). Multivariable analysis showed that comorbidity (OR = 0.28, 95% CI 0.22–0.46; 72% lower odds of adherence), number of emergency visits (OR = 0.92, 95% CI 0.85–0.98; 8% lower odds per additional visit), and receiving disease-related education (OR = 7.67, 95% CI 3.65–16.12; 7.67-fold higher odds of adherence) were independently associated with adherence. Conclusion: The findings highlight the need for targeted interventions, especially for those with comorbidities, frequent emergency visits, and a lack of disease-related education, to improve medication adherence in patients with COPD. Practice Implications: Improving inhaler adherence in COPD may benefit from structured patient education programs, post-discharge follow-up after emergency visits, and nurse-led or multidisciplinary adherence monitoring strategies.