Assessment of Patient Attitudes About Mometasone Furoate Nasal Spray: The Ease-of-Use Patient Survey

Background Intranasal corticosteroids (INS) are recommended as first-line therapy for allergic rhinitis. To date, no studies have evaluated the impact of an INS delivery system on patient satisfaction. Unless patients use a medication appropriately and consistently, they will not fully benefit from its therapeutic effects. Objective To determine whether the characteristics of the mometasone furoate nasal spray (MFNS) delivery device are an impediment to its use. Methods/Database A random sample of preidentified MFNS users was recruited through e-mail (N = 1544). In online interviews, participants were asked about MFNS ease of use and attributes. Results Ninety-eight percent of respondents reported that MFNS is easy to use, and 96% said that the applicator is easy to administer. Nearly all elderly users and users with arthritis said that the applicator fits comfortably in the nostril (96% and 97%, respectively) and is appropriately sized (97% and 96%, respectively); 96% of pediatric users agreed that the applicator fits comfortably. All users said the applicator's ease of use and comfortable fit were its most important attributes. Conclusions The perceived ease of use of MFNS may help providers appropriately treat patients with allergic rhinitis and may improve patient adherence to INS use.


Assessments
Respondents were asked 11 questions assessing their attitudes about ease of use of MFNS (Table 1). To determine which characteristics were most important to users, respondents were asked to make a more critical assessment of product attributes through a maximal differential technique, based on a Latin square (balanced order and pairing) design. Respondents viewed 5 claims about product attributes at once and were asked to select which were the most important and which were the least important attributes. Each claim was exposed and reacted to 3 times, providing a more robust evaluation than a single assessment. The analysis for each criterion was summarized into 1 measure. The maximal differential analysis does not use a scale; it derives measures without rating the claim.

Subjects
The random sample included 1544 respondents, of whom 506 were pediatric (aged 2Y17 years; half were administered MFNS by a caregiver and half self-administered MFNS), 355 were elderly, and 562 (including 227 elderly) were arthritis sufferers (some respondents may have been in more than 1 group). The demographics of the sample population are summarized in Table 2.

Total Sample
In the total sample, 98% reported that MFNS is easy to use, 96% reported that the mist from the applicator is easy to administer, and 96% reported that the applicator is easy to pump and press (Table 3). Similar numbers were noted for the questions about the applicator's comfort in the hand. Overall, 85% of total users said that they liked using the MFNS pump bottle.

Pediatric Users
Among pediatric users, 96% of those who administer MFNS themselves said that the Bapplicator fits comfortably in the nostril[; 92% of caregivers agreed with that statement. Nearly 100% of those in both groups reported that MFNS is easy to use, and more than 90% said that it was easy to administer and that the applicator was comfortable to hold. However, although 93% of caregivers reported that they liked using the MFNS pump bottle, only 77% of self-users agreed with that statement, the lowest percentage of any of the subgroups.

Elderly Users and Users With Arthritis
Nearly all elderly users and users with arthritis agreed that the Bapplicator fits comfortably in the nostril[ (96% and 97%, respectively) and is Bappropriately sized to administer the medicine[ (97% and 96%, respectively). These rates were similar to those of the general users. Both subgroups found MFNS easy to administer (Q95%) and to pump/press (95%). Ninety-five percent of elderly users and 93% of users with arthritis reported that the applicator was comfortable to hold and fit well in the hand. The response rate to Blike using the MFNS pump bottle[ was 84% for elderly users and 83% for users with arthritis.

Maximum Differential Analysis
All categories of MFNS users selected ease of administration features such as Bthe mist is easy to administer,[ Bis easy  Values were expressed as no. (%). *There were 2 subgroups within the pediatric sample of the study. Half of the pediatric patients self-administered MFNS, and half had MFNS administered by a caregiver (ie, parent). Of those administered by a caregiver, 100% were female (mother of the child). For those who self-administered, because of the children's age (G18 years), sex and other demographic information were not provided. to use,[ and Bis easy to pump/press[ as the most important attributes (Table 4). Other characteristics considered important among pediatric caregivers, the elderly, and users with arthritis included Bthe applicator fits comfortably in the nostril[ and Bis appropriately sized to administer the medicine.[ The least important characteristic was Bis easy to store.[ DISCUSSION Individual product attributes of different INS are readily distinguishable by patients. Patient acceptance and satisfaction with these attributes may influence their medication preferences and, ultimately, treatment adherence. One survey conducted in 2000 adults with AR found that 80% of respon-dents were noncompliant with a range of treatments for various reasons, including that the medication was inconvenient to take. 27 A lack of adherence to INS therapy can then lead to inadequate treatment of AR and subsequent problems such as a greater number of office visits and decreased productivity and increased absenteeism at work or school. 28 In light of these facts, the results of this survey, showing that the great majority of patients using the MFNS applicator agree that it is easy to use, are important.
This survey reports data for subgroups of INS users: pediatric patients, elderly patients, and individuals with arthritis. The results support those of a recent product accessibility study conducted on behalf of the Arthritis Foundation, where MFNS Values were presented as the percentage of users with positive answers to questions. *The attributes were listed by general order of derived importance rather than by question number. *The ranking data in this table were derived from patients' selection of most important survey statements, with the larger numbers identifying the most important; the methodology used was a maximum differential analysis. was evaluated by 8 subjects with arthritis (mean age, 65 years) to determine accessibility and ease of use. Ten tasks were administered: 6 tasks were related to opening the package and reading information and 4 tasks were related to physical use. Subjects rated MFNS on a scale ranging from 1 = not at all easy to use to 5 = extremely easy to use. The mean overall score for all 10 tasks was approximately 4.25, indicating a high degree of ease of use of MFNS among patients with arthritis.

CONCLUSIONS
Among all categories of MFNS users in this survey, greater than or equal to 97% reported that MFNS is easy to use. Nearly all pediatric users, elderly users, and users with arthritis agreed that the applicator fits comfortably in the nostril and is appropriately sized to administer the medicine, and that the drug is easy to administer. The high ratings given to the ease of use of MFNS in this survey may support providers in their efforts to improve patients' adherence to AR treatment regimens.