Abstract
Introduction: Non-adherence to inhaled corticosteroids (ICS) in children
with asthma leads to significant morbidity and mortality. Few
interventions to improve adherence have been effective and little is
known about what contributes to intervention effectiveness. This
systematic review summarises the efficacy of these interventions and the
characteristics of effective interventions to inform future studies
aiming to improve adherence to ICS in children with asthma. Methods:
PubMed, Embase, PsychINFO, Medline, Web of Science, and International
Pharmaceutical Abstracts were systematically searched on the 3rd of
October 2020 for randomised control trials measuring adherence to ICS in
children with asthma. A narrative synthesis was conducted focusing on
intervention efficacy and study reliability. Intervention content was
coded based on the NICE guidelines for medicines adherence (The
Perceptions and Practicalities Approach, PAPA) and Behaviour Change
Techniques (BCT), to determine the effective aspects of the
intervention. Results: Of 240 studies identified, 25 were eligible for
inclusion. Thirteen of the twenty-five studies were categorised as being
highly reliable. Nine of the thirteen studies were effective at
increasing adherence and six of those met the criteria for a PAPA
intervention. Conclusion: Adherence interventions in children with
asthma have mixed effectiveness. Effective studies tended to be of
higher quality, were tailored to individuals perceptual and practical
adherence barriers, and used multiple BCTs. However, due to the small
number of included studies and varying study design quality, conclusions
drawn here are preliminary. Future research is needed to test a
PAPA-based intervention with a rigorous study design as outlined in this
review