The Association of COPD Patients' and Caregivers' KAP with Inhaler Adherence: An Actor-Partner Interdependence Model Analysis

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.