A Systematic Review of Patient and Family-Level Inhaled Corticosteroid Adherence Interventions in Adult African-Americans

Publication date: Available online 3 November 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Isaretta L. Riley, Beverly Murphy, Zayd Razouki, Jerry A. Krishnan, Andrea Apter, Sande Okelo, Monica Kraft, Cindy Feltner, Loretta G. Que, L. Ebony Boulware

Abstract

Background

Inhaled corticosteroid (ICS) adherence rates are suboptimal among adult African-Americans. Comprehensive studies characterizing the effectiveness and the methodological approaches to the development of interventions to improve ICS adherence in adult African-Americans have not been performed.

Objective

Conduct a systematic review of patient/family-level interventions to improve ICS adherence in adult African-Americans.

Methods

Searched MEDLINE, EMBASE, Web of Science, and CINAHL from inception to August 2017 for English-language United States studies enrolling at least 30% African-Americans comparing patient/family-level ICS adherence interventions with any comparator. Two investigators independently selected, extracted data from, and rated risk-of-bias. We collected information on intervention characteristics, outcomes, and assessed whether studies were informed by behavior theory and/or stakeholder engagement.

Results

Among 1,661 abstracts identified, we reviewed 230 full-texts and identified 4 randomized controlled trials (RCT) and 1 quasi-experimental (pre-post design) study meeting criteria. Study participants (N range 17-333) varied in mean age (22-47 years), proportion African-Americans studied (71%-93%), and gender (69%-82% female). RCTs evaluated problem solving classes, self-efficacy training, technology-based motivational interviewing program and the use of patient advocates. The RCT testing self-efficacy training was the only intervention informed by both behavior theory and stakeholder engagement. All 4 RCTs compared interventions with active control and rated as medium risk-of-bias. No RCTs found a statistically significant improvement in adherence.

Conclusion

Few studies assessing asthma adherence interventions focused on adult African-American populations. No RCTs demonstrated improved ICS adherence in participants. Future studies are needed that are informed by behavior change theory and stakeholder engagement.

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