The Association of COPD Patients' and Caregivers' KAP with Inhaler Adherence: An Actor-Partner Interdependence Model Analysis.
- 1Department of Respiratory Medicine and Critical Care, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People's Republic of China.
Abstract
Purpose
Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality, yet inhaler adherence remains suboptimal. Caregivers may play a critical role in patients' medication behavior, but the underlying mechanisms are poorly understood. This study aimed to examine the actor and partner effects of knowledge, attitude, and practice (KAP) levels among COPD patients and their caregivers on patient inhaler adherence.Patients and methods
Using convenience sampling, 150 COPD patient-caregiver dyads were recruited from a tertiary hospital in Xuzhou, China, between March and June 2026. KAP levels were assessed using a self-designed questionnaire, and patient inhaler adherence was evaluated using the Chinese version of the Test of Adherence to Inhalers (TAI). Data were analyzed within the Actor-Partner Interdependence Model (APIM) framework with paired cluster-robust standard errors. Seven pre-specified covariates were adjusted, and all continuous variables were standardized using Z-scores before model inclusion.Results
The mean TAI score was 42.5 ± 9.8, with 63.3% of patients showing low adherence. The actor effect of patient KAP on their own adherence was significant (β = 0.141, P = 0.016; β* = 0.152), and the partner effect of caregiver KAP on patient adherence was also significant (β = 0.293, P < 0.001; β* = 0.537). Sensitivity analysis revealed that the attitude dimension exerted the strongest partner effect (β* = 0.566, P < 0.001), which was significantly stronger than practice (β* = 0.488, P = 0.001) and knowledge (β* = 0.394, P < 0.001).Conclusion
Caregiver KAP is more strongly associated with patient inhaler adherence than patients' own KAP, with the attitude dimension playing a dominant role. Clinical interventions targeting caregivers as a core strategy, shifting the focus from knowledge transfer to belief reshaping and behavioral skill training, may hold promise for improving inhaler adherence, although prospective studies are needed to confirm these associations.
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BibTeX
@article{liu2026association,
title = {{The Association of COPD Patients' and Caregivers' KAP with Inhaler Adherence: An Actor-Partner Interdependence Model Analysis.}},
author = {Cuican Liu and Haifeng Zheng and Mingyue Gao and Lixiang Sun and Lu Han and Ni Gao},
journal = {International journal of chronic obstructive pulmonary disease},
year = {2026},
month = oct,
doi = {10.2147/copd.s634930},
url = {https://europepmc.org/article/MED/42903722},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - The Association of COPD Patients' and Caregivers' KAP with Inhaler Adherence: An Actor-Partner Interdependence Model Analysis.
AU - Cuican Liu
AU - Haifeng Zheng
AU - Mingyue Gao
AU - Lixiang Sun
AU - Lu Han
AU - Ni Gao
PY - 2026
DA - 2026/10/16
JO - International journal of chronic obstructive pulmonary disease
DO - 10.2147/copd.s634930
UR - https://europepmc.org/article/MED/42903722
AB - Purpose Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality, yet inhaler adherence remains suboptimal. Caregivers may play a critical role in patients' medication behavior, but the underlying mechanisms are poorly understood. This study aimed to examine the actor and partner effects of knowledge, attitude, and practice (KAP) levels among COPD patients and their caregivers on patient inhaler adherence.Patients and methods Using convenience sampling, 150 COPD patient-caregiver dyads were recruited from a tertiary hospital in Xuzhou, China, between March and June 2026. KAP levels were assessed using a self-designed questionnaire, and patient inhaler adherence was evaluated using the Chinese version of the Test of Adherence to Inhalers (TAI). Data were analyzed within the Actor-Partner Interdependence Model (APIM) framework with paired cluster-robust standard errors. Seven pre-specified covariates were adjusted, and all continuous variables were standardized using Z-scores before model inclusion.Results The mean TAI score was 42.5 ± 9.8, with 63.3% of patients showing low adherence. The actor effect of patient KAP on their own adherence was significant (β = 0.141, P = 0.016; β* = 0.152), and the partner effect of caregiver KAP on patient adherence was also significant (β = 0.293, P < 0.001; β* = 0.537). Sensitivity analysis revealed that the attitude dimension exerted the strongest partner effect (β* = 0.566, P < 0.001), which was significantly stronger than practice (β* = 0.488, P = 0.001) and knowledge (β* = 0.394, P < 0.001).Conclusion Caregiver KAP is more strongly associated with patient inhaler adherence than patients' own KAP, with the attitude dimension playing a dominant role. Clinical interventions targeting caregivers as a core strategy, shifting the focus from knowledge transfer to belief reshaping and behavioral skill training, may hold promise for improving inhaler adherence, although prospective studies are needed to confirm these associations.
SN - 1176-9106
SN - 1178-2005
ER -