The use of a questionnaire underpinning capability, opportunity, and motivation to determine the psychological and behavioural barriers to adherence in patients with asthma (The COM-B asthma study).

Alice Munns*, Laura Wiffen, Thomas Brown, Alessandra Fasulo, Milan Chauhan, Leon D. Cruz, Daphne Kaklamanou, Anoop Chauhan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Asthma is a common lung condition that cannot be cured, but it can usually be effectively managed using available treatments. Despite this, it is widely acknowledged that 70% of patients do not adhere to their asthma treatment. Personalizing treatment by providing the most appropriate interventions based on the patient's psychological/behavioral needs, produces successful behaviour change. However, health care providers have limited available resources to deliver a patient-centred approach to their psychological/behavioural needs, resulting in a current one-size-fits-all strategy due to the non-feasible nature of existing surveys. The solution would be to provide health care professionals with a clinically feasible questionnaire that identifies the patients personal psychological/behavioural factors to adherence.

Objective: This study aims to apply the COM-B questionnaire to detect a patient's perceived psychological and behavioural barriers to adherence. As well as explore the key psychological and behavioural barriers indicated by the COM-B questionnaire and adherence to treatment in patients with confirmed asthma with heterogenous severity. Exploratory objectives will include focus on the associations between the COM-B questionnaire responses and asthma phenotype, including clinical, biological, psychosocial and behavioural components.

Methods: In a single visit, participants visiting Portsmouth Hospital asthma clinic with a diagnosis of asthma will be asked to complete a 20-minute questionnaire on an iPad, about their psychological and behavioural barriers following the theoretical domains framework and capability, opportunity, and motivation model. Participants routinely collected data, including demographics, asthma characteristics, asthma control, asthma quality of life, medication regime, will be recorded onto an electronic data capture form.

Results: The study is already underway, and it is anticipated that the results will be available in 2022.

Conclusions: The COM-B asthma study will investigate into an easily accessible theory-based tool (a questionnaire) for identifying psychological and behavioural barriers in asthma patients who are not adhering to their treatment. This will provide useful information on the behavioural barriers to asthma adherence and whether or not a questionnaire can be used to identify these needs. The highlighted barriers will improve health care professionals' knowledge on this important subject, and participants will benefit from the study by removing their barriers. Overall, this will enable healthcare professionals to use effective individualised interventions to support improved medication adherence while also recognising and meeting the psychological needs of asthma patients.
Original languageEnglish
JournalJournal of Medical Internet Research
Publication statusAccepted for publication - 16 Feb 2023


  • Asthma
  • Adherence
  • COM-B
  • behavioural and psychological barriers
  • Theoretical Domains Framework
  • behaviour change

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