Improving Adrenaline Autoinjector Adherence: a Psychologically-informed Training for Healthcare Professionals

Mahoney, Berenice ORCID: https://orcid.org/0000-0002-7414-8185, Walklet, Elaine, Bradley, Eleanor ORCID: https://orcid.org/0000-0001-5877-2298 and O'Hickey, Stephen (2019) Improving Adrenaline Autoinjector Adherence: a Psychologically-informed Training for Healthcare Professionals. Immunity, Inflammation and Disease, 7 (3). pp. 214-228. ISSN Online: 2050-4527

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Abstract

Background: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline auto-injectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use auto-injectors. Health Psychology principles suggest exploring these factors with patients could improve their auto-injector use.
Objective: To evaluate the impact of a 90 - minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to auto-injector use with patients. Attendees’ knowledge, confidence and likelihood of using the strategies were expected to improve.
Methods: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence and likelihood of using the strategies taught were evaluated online one week before, 1–3 and 6–8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact.
Results: Chi-square analyses were significant in most cases (p <.05), with sustained (6–8 weeks) improvements in knowledge, confidence and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees’ knowledge of the care pathway, understanding of patient’s experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts.
Conclusion: Training clinicians in psychologically- informed strategies produce sustained improvements in their confidence and knowledge around patient auto-injector education, and their likelihood of using strategies in clinical practice.
Clinical Relevance: Exploring psychological barriers should be part of training patients with anaphylaxis in auto - injector use.

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