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Welcome to the Peers in Practice inhale hub. Here you will find information to support your COPD consultations with your patients

Adverse events reporting and prescribing information can be found at the bottom of the page.

This material was developed in collaboration with a UCL business company, Spoonful of Sugar, industry leaders in the application of validated behavioural science frameworks and tools developed from extensive research into helping patients and healthcare professionals to get the best from treatments by enhancing engagement, adherence and persistence to optimise health.1

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Understanding
Behavioural Change

NICE guidelines recommend that COPD patients adopt a wide range of healthy behaviours into their daily lives, including from smoking cessation, inhaled therapies and pulmonary rehabilitation etc2 but not all patients are able to succeed in making these lasting behavioural changes.

So why do some COPD patients say No to Change?

Use this page to understand patients’ hesitancy to change, by exploring their potential perceptions and behaviours using well-established and proven behavioural science frameworks.

PAPA framework overview

Explore PAPA™

If we want patients to adopt a new behaviour, we need to understand what drives behaviour change.

Let’s take non-adherence to a different inhaler as an example. The reasons why patients don't take their medicine can be summarised as “I don’t want to do it” and “I can’t do it”.3

Don’t want to is a question of motivation.

This is a Perceptual barrier.

Can’t do it is a question of ability.

This is a Practical barrier.

To overcome both types of barriers, the patient discussion needs to:

The two key attributes considered essential for behaviour are motivation and ability. To bring about behaviour change, we must address both the perceptions that drive motivation and the practicalities that influence the ability to act.3

  1. Increase motivation

    Provide a rationale for why adherence to a new inhaler will help them to achieve something that is important to them, and address any misplaced concerns.

  2. Increase ability

    Make it as easy and convenient as possible for them to switch to a new inhaler.

Smiling male nurse in inhale bubble

A deeper dive into motivation…

The Necessity-Concerns Framework is a model explaining how our motivation to start and persist with a behavioural change is strongly influenced by our perception of personal need for the action, relative to our concerns about doing it.

For example, if patients can have a different set of concerns for each COPD medicine they are prescribed. The patient will continue to be non-adherent unless any misplaced concerns are elicited and addressed.

NCF framework overview

The Necessity-Concerns Framework (NCF™) identifies the key perceptions influencing motivation to engege with treatment. It is disease-agnostic framework that has been validated in global studies across illness and healthcare system.3,4

Necessity

If we think about medicines, necessity beliefs can be categorised as the answer to these questions: “How much do I need this medicine to achieve a goal that is important to me?” and “How much can I get away without taking it?”.

Concerns

Concerns can be thought of as the answer to the question: “What are the downsides for me?”, representing the potential adverse effects of a medicine. They don’t just include side effects, but also negative long-term effects related to dependency and the accumulation of medicines within the body.

Patients can believe a medicine will be effective but not value that particular benefit for themselves and believe there are better ways to manage their condition.

For instance, a patient accustomed to using twice-daily inhalers may resist switching to a once-daily regimen, even if the latter offers improved convenience and similar efficacy, due to their long-term familiarity with their current treatment. These could indicate low beliefs in the personal need for treatment and may lead to a patient becoming non-adherent.

Visit our Discussing with Patients page for expert tips on addressing common doubts and concerns
Example COPD patient 1
Nurse with arm on desk

‘Nudge’ is a useful tool applying insights from behavioural science, often used in healthcare and for policy improvement. Nudge is about shaping the environment so that people will be prompted to make better choices.5

However, there are some circumstances where nudges will not work and could potentially backfire. Nudging only works if people hold a positive mindset about their behaviour being ‘nudged’. As medicines have the potential for harm, attempting to nudge people into taking something they may consider to be toxic could lead to a complete loss of trust.

Therefore, a Nudge is best used in combination with other initiatives that facilitate informed choice rather than as a single strategy to change patient behaviour.

Behaviour Change Psychology – Key Points

  • To bring about behaviour change, address the perceptual barriers that influence motivation and the practical barriers that influence the ability to act
  • Motivation for change is influenced by our belief in the personal need for the action relative to our concerns about negative effects
Smiling nurse with fictional COPD patient

Together, we can support patients in making positive changes to help manage their COPD

Explore Practical Tips Now
References
  1. Spoonful of Sugar – making the most of medicines. Available from sosadherence.co.uk
  2. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management [NG 115]. Available at: https://www.nice.org.uk/guidance/ng115
  3. Horne R, et al. Eur Psychol. 2019: 24(1): 82-96
  4. Horne R, et al. PLoS One 2013; 8: e80633.
  5. Thaler RH, et al. Penguin. 2009

November 2024 | PM-GB-CPU-WCNT-240005

For the GB and NI Trelegy Ellipta® (fluticasone furoate/umeclidinium/vilanterol) prescribing information Click here.