Factors Impacting Adherence to Saline Nasal Irrigation Treatment in an Urban Population

Background Saline nasal irrigation (SNI) is an effective first-line treatment for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), yet adherence remains challenging. Better understanding of adherence patterns and related barriers is important for the development of patient-centered interventions to improve adherence. Objective To investigate adherence to SNI in patients with AR and CRS, including clinical and sociodemographic predictors of adherence, reported barriers to adherence, and patient-recommended methods to increase adherence. Methods Adult patients treated with SNI for AR or CRS at our medical center in January 2024 were surveyed via phone in December 2024, and their medical records were reviewed. The primary outcome was adherence rate. Secondary outcomes included patient-reported barriers and proposed methods for improving adherence. Results Of 174 patients surveyed, 38.9% were adherent. Adherence was significantly associated with English as a primary language ( P = .026) and history of allergies ( P = .043), with a borderline significant association with prior endoscopic sinus surgery (ESS) ( P = .053). The most cited barriers were logistical issues ( n = 26, 21.3%), discomfort or pain ( n = 21, 17.2%), forgetting ( n = 17, 13.9%), and the time required ( n = 16, 13.1%). The most commonly suggested interventions were better instructions for use ( n = 28, 28.0%), increased education about SNI ( n = 27, 27.0%), offering a list of affordable options ( n = 24, 24.0%), and help setting up reminders ( n = 21, 21.0%). Conclusion In our urban population, adherence to SNI among patients with AR and CRS is relatively low. English speakers, those with allergies, and those with prior ESS are more likely to adhere. Barriers include logistics, discomfort, forgetfulness, and time commitment. Patient-centered interventions such as education, clearer instructions, cost transparency, and reminders may increase adherence.