Chronic Obstructive Pulmonary Disease: An Analysis of Online Patient Testimony on Treatment Adherence

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Abstract
Objectives: The objective of this study was to explore the views expressed online by COPD patients regarding adherence to inhaled therapy. Methods: This study applied a qualitative, exploratory-interpretive design and an inductive methodology. Sources analyzed included COPD websites, patient forums, and social networks. Units of analysis were videos, stories, questions and answers, and conversation threads. Saturation criteria were applied. Applying a constant comparative methodology, analyses were conducted at textual (quotes, initial and focused coding, families) and conceptual (categories, networks, meta-network, provisional and final model) levels using ATLAS.ti 7.5. Reports were returned to patients. Results: There were 248 patients (51 men, 148 women, 49 unidentified) corresponding to 29 testimonies (6 narratives, 11 videos, 10 conversation threads, 2 questions collections). Adherence to inhalers is based on their perception of effectiveness to enable a normal life, and benefits should outweigh adverse effects. Adherence facilitators included mutual support between patients encouraging adherence and effective doctor-patient communication. Adherence barriers included (1) side effects; (2) mistaken beliefs about inhalers (habituation, attribution of non-existent side effects, fear of corticosteroids); (3) poor doctor-patient relationship (lack of listening, failure to consider patient’s preferences, communication iatrogenesis); (4) considering natural remedies as substitutes for treatment. Conclusions: Adherence to inhalers as reported in online testimony from COPD patients depends on the balance between efficacy and side effects. Adherence is influenced by peer support and doctor-patient communication. Doubts, erroneous beliefs, and iatrogenic effects of poor communication can hinder adherence.

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