The 32 cons participants gave for electronically monitoring inhaler use, with the number of times each point was raised
| Cons | Sum |
|---|---|
| 1. Cost of devices | 32 |
| 2. Bulkiness and appearance may put patients off | 14 |
| 3. Patient may not like being ‘watched’ | 12 |
| 4. Accuracy and reliability of the device, as well as potential technical issues | 9 |
| 5. Concerns over the time and workload this would add to the consultation process | 9 |
| 6. Concerns if this is only compatible with MDIs | 7 |
| 7. Records actuation but not inhalation, technique, nor identifies if canister is empty or inhaler is shared | 7 |
| 8. Whose responsibility is downloading, processing and interpreting the data and discussing with patients? | 7 |
| 9. How is data stored and who has access? | 6 |
| 10. An EMD may be required for more than one inhaler per patient | 5 |
| 11. Evidence of the effectiveness of EMDs is required | 4 |
| 12. Cleaning and maintenance of the device | 3 |
| 13. Concerns about the role of pharma companies | 3 |
| 14. Could interfere with inhalation technique or not be compatible with spacer | 3 |
| 15. Data overload | 3 |
| 16. Ease of use—another thing patients have to learn | 3 |
| 17. Elderly patients may struggle with the technology or have a negative attitude towards it | 3 |
| 18. May make no difference to already unengaged patients | 3 |
| 19. May put patients off coming to clinic particularly if they have failed | 3 |
| 20. Paternalistic approach | 3 |
| 21. Added cost/time/workload of training clinicians and staff on how to use device, how to teach patients and how to interpret results | 2 |
| 22. Are there better alternatives, for example, Tele-health or Medication Possession Ratio (MPR)? | 2 |
| 23. Over-reliance on data—also need to determine reasons for non-adherence | 2 |
| 24. Patient may forget to bring device with them to clinic | 2 |
| 25. Patient resistance or refusal to use the device | 2 |
| 26. Patients may find the reminders a nuisance | 2 |
| 27. Bad for the environment—plastic and batteries | 1 |
| 28. Could create potential conflicts between the patient and their clinician or parents | 1 |
| 29. Many who get this device may do so as there are adherence concerns and therefore will show (inevitably) that adherence is poor | 1 |
| 30. More benefits for researchers than patients, meaning patients may fail to see worth | 1 |
| 31. Non-adopters lead to selection biases | 1 |
| 32. This will not address intentional non-adherence | 1 |
EMD, electronic monitoring device.