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Role of habit in treatment adherence among adults with cystic fibrosis
  1. Zhe Hui Hoo1,2,
  2. Benjamin Gardner3,
  3. Madelynne A Arden4,
  4. Simon Waterhouse5,
  5. Stephen J Walters1,
  6. Michael J Campbell1,
  7. Daniel Hind5,
  8. Chin Maguire5,
  9. Jane Dewar6,
  10. Martin J Wildman1,2
  1. 1 School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  2. 2 Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
  3. 3 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
  4. 4 Centre for Behavioural Science & Applied Psychology (CeBSAP), Sheffield Hallam University, Sheffield, UK
  5. 5 Sheffield Clinical Trials Research Unit (CTRU), University of Sheffield, Sheffield, UK
  6. 6 Department of Respiratory Medicine, Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to Dr Zhe Hui Hoo, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DP, UK; z.hoo{at}


Among adults with cystic fibrosis (CF), medication adherence is low and reasons for low adherence are poorly understood. Our previous exploratory study showed that stronger ‘habit’ (ie, automatically experiencing an urge to use a nebuliser) was associated with higher nebuliser adherence. We performed a secondary analysis of pilot trial data (n=61) to replicate the earlier study and determine whether habit–adherence association exists in other cohorts of adults with CF. In this study, high adherers also reported stronger habit compared with low adherers. Habit may be a promising target for self-management interventions.

Trial registration number ACtiF pilot, ISRCTN13076797.

  • cystic fibrosis
  • psychology

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  • Contributors ZHH, BG, MJW: concept and design. ZHH, SW, CM: data acquisition. ZHH: drafting the manuscript. All authors were involved in the analysis and interpretation of data, and critically revised the manuscript and approved the final draft.

  • Funding This report presents independent research funded by the NIHR under its Grants for Applied Research Programme (Grant Reference Number RP-PG-1212-20015) and a Doctoral Research Fellowship (ZHH, Award Identifier DRF-2014-07-092).

  • Disclaimer The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, Medical Research Council (MRC), Central Commissioning Facility (CCF), NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), the Programme Grants for Applied Research Programme, or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Sheffield study was approved by the London – Westminster Research Ethics Committee (15/LO/0328). The ACtiF pilot study was approved by the London – Brent Research Ethics Committee (16/LO/0356).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for the Sheffield study are archived by the Sheffield Teaching Hospitals NHS Foundation Trust, and are available upon request (ZHH, clinical research fellow, for researchers who meet the criteria for robust prespecified data analysis plan and for access to confidential data. Data for the two-centre pilot trial are archived by the University of Sheffield, and are available upon request (CM, trial manager, for researchers who meet the criteria for robust prespecified data analysis plan and for access to confidential data. To access either data set, a formal request will need to be submitted and considered on a case-by-case basis.