Table 1.

Examples of How Focus Group Results Guided Development of IVR Script Design and Content

Participant Identified Barriers to Asthma Medication Adherence	Attributes	Illustrative Quotes from Focus Group Participants	Sample IVR Script Content and Language Influenced by Focus Group Findings
Lack of Routine	- no routine at all	-“What do you do to remind yourself-because it’s not like a pill where you can take it on Tuesday, open it up and see that you haven’t taken it yet.”.	Tardy Call: “Many people with breathing concerns also find that they often forget to take their medication. Do you sometimes find it difficult to remember to take your [drug name]?”
	- routine for 1 dose but not the other dose (morning versus evening routines)	-“I have a routine in the morning – shower, comb hair, deodorant, sprayer [medication], brush teeth – in that order every morning. But the evening, there is no routine for the evening so I sometimes forget.”	IF YES“ Many people do find that it takes time to develop a routine for making medication a part of their daily lifestyle. You may find it helpful to think of it as something you need to do as part of some daily routine. You might try putting your [DRUG NAME] in a location where you will see it and remember to use it. For example, keep it by the bathroom sink so you can use it before you brush your teeth or in the kitchen so you can take it after one of your meals. If you feel comfortable doing so, you can always ask a family member or close friend to help make it a part of your routine. And please remember that your doctor and [HEALTHPLAN] pharmacy department also can be great resources for helping you find ways to remember to take your medication every day.”
	- difficulty “getting all the doses in” in one day	-“I try REAL hard not to miss both morning and night time doses, but I have some nights I am so tired I don’t have the energy to go through the process of taking it.”
Forgetfulness	- overwhelmed by responsibilities of a “busy life”	-“I forget to take it in the morning so I take it to work with me. But then I get busy at work and don’t have the time to take it.”	- All call types: “taking your [drug name] every day is one of the most important things you can do to help control your breathing.”
	-“in a hurry” during daily transition times	-“I just do it in the morning and sometimes I do forget because I am in a hurry to get out the door.”	-All Call types: Many people also find that they simply have trouble remembering to fill their prescriptions. Is this true for you?
			IF YES “then we hope you’ll find this Refill Reminder Program helpful.”
Lack of Understanding about Medications	- lack of clear understanding as to “why my body needs” the medication	-“I need a better understanding…If I have a clear understanding of, ‘You need to take THIS medicine because this is what’s going on internally and this is what the medicine will do to help you,’ then I’m going to be more likely to take it.”	- All call types: “…one of the most important things you can do to help control your breathing is to take your [DRUG NAME] every day as prescribed, even if your breathing is already in good control.
	- lack of understanding, education, and reinforcement regarding the purpose of the medication and differences between controller and reliever medications	-“I think they should tell you that even though you feel better you should still take the Qvar. I didn’t realize that until I talked to my provider again. And I think they REALLY need to stress that.”	-Tardy and New User call types: If Poor control indicated by participant response, “Nighttime wakening, interference with daily activities, and the need for frequent use of your reliever medication are all signs that your breathing could be in better control. So you may want to speak with your doctor about how your breathing difficulties are affecting your life right now. Also, keep in mind that the best way to stay in good control is to take your [DRUG NAME] every day, even when you are feeling well.
	- often receive education and reinforcement during “acute attacks” when less likely to absorb, retain, and understand information	-“I don’t think I got enough of what I need to know to manage it during my visit. So for me, I may not understand it totally…”	-New User Call[ICS education module] “Your [DRUG NAME] is what is known as a controller medication which is used to prevent symptoms from occurring by keeping your airways from becoming irritated. Keep in mind that when you first start taking [DRUG NAME] it may not work right away. In fact, most people don’t see an effect for up to two weeks of daily use. Also unlike steroid pills, such as prednisone which can have side effects, your [DRUG NAME] is considered to be very safe to take for long periods of time. And remember, this medication works best when you use it every day. Would you like me to repeat that?”
Feeling Good	-feel good/no noticeable symptoms so choose not to fill	-“My asthma was not bothering me, so I got lazy and ran out of it [medication].”	New User and Tardy Calls: “One common reason people give for not taking their breathing medications is that they’re feeling well and don’t think they need to take them. Is this sometimes true for you?”
	-feel good/no noticeable symptoms so forget to fill	-“The problem with Qvar is if you are feeling good and don’t take it, you don’t notice anything, like more coughing, for another week or two.”	IF YES [ICS education module] same as above: “Your [DRUG NAME] is what is known as a controller medication which is used to prevent symptoms….”