Applying the Health Belief Model to Identify Factors Associated With Owner Persistence to Allergen-Specific Immunotherapy.

Abstract

BACKGROUND: Allergen-specific immunotherapy (ASIT) is the only treatment targeting the pathophysiology of canine atopic dermatitis (cAD) and feline atopic skin syndrome (FASS). Despite its disease-modifying potential, owner persistence remains a clinical challenge. This study applied the Health Belief Model (HBM) to evaluate factors influencing owner persistence with ASIT. HYPOTHESIS/OBJECTIVES: We hypothesised that owner perceptions of ASIT effectiveness, perceived barriers (e.g., cost) and ease of treatment integration would be associated with persistence. The objective was to identify modifiable psychological and logistical factors to support sustained ASIT use in cAD and FASS management. ANIMALS: No animals were used. MATERIALS AND METHODS: Pets prescribed ASIT between 1 January 2020 and 31 May 2024, were identified from four geographically diverse veterinary dermatology practices. Owners completed a survey assessing HBM constructs-perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, social support-and a knowledge domain. Owner-reported ASIT refill behaviour served as a proxy for persistence. Associations between HBM constructs and refill behaviour were evaluated using chi-square tests and logistic regression. RESULTS: Higher perceived disease severity, greater perceived benefits and increased self-efficacy were positively associated with persistence. Owners who viewed their pet's condition as severe, believed ASIT effective, or felt confident administering treatment were more likely to continue therapy. Cost concerns and administration challenges were key perceived barriers. CONCLUSIONS AND CLINICAL RELEVANCE: This study highlights the psychological factors in owner persistence with ASIT. HBM-informed educational strategies that emphasise disease impact, treatment value and owner confidence may improve persistence with ASIT and long-term disease management.