I do not want to suppress the natural process of inflammation: new insights on factors associated with non-adherence in rheumatoid arthritis

Abstract

BackgroundIt is estimated that 50–70% of patients with rheumatoid arthritis (RA) are non-adherent to their recommended treatment. Non-adherent patients have a higher risk of not reaching an optimal clinical outcome. We explored factors associated with nonadherence from the patient’s perspective.MethodsFour hundred and fifty-nine RA patients (346 (75.4%) females; mean age 63.0 ± 14.8 years) who failed to attend follow-up visits in two rheumatology centres were eligible to participate in a qualitative interview study. We used this strategy to identify patients who were potentially non-adherent to medicines and/or non-pharmacological interventions. By means of meaning condensation analysis, we identified new and some already well known insights to factors associated with non-adherence. We used the capability, opportunity, and motivation model of behaviour (COM-B) model as a frame of reference to classify the factors.ResultsForty-three of 131 patients (32.8%) who agreed to participate in the qualitative interviews were found to be non-adherent. New insights on factors associated with non-adherence included strong opinions of patients, such as pain being considered as an indicator of hard work and something to be proud of, or inflammation being a natural process that should not be suppressed; feeling not to be in expert’s hands when being treated by a physician/health professional; the experience of excessive self-control over the treatment; and rheumatologists addressing only drugs and omitting non-pharmacological aspects. The COM-B model comprehensively covered the range of our findings.ConclusionsThe new insights on factors associated with non-adherence allow a better understanding of this phenomenon and can substantially enhance patient care by helping to develop targeted interventions.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1732-7) contains supplementary material, which is available to authorized users.

Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group

“…Replies were gathered for 24 h. Information provided by the EPDWG members was analyzed using a modified form of meaning condensation analysis. [27,28] Email replies were first read through to gain an overview of the collected data, after which themes were extracted and clustered according to common meanings. Clustered themes and corresponding quotations for each center were synthesized in a summary of finding table sent to all participants.…”

“…Replies from rounds 2 and 3 were collected within 48 h. After the third Delphi round, no new information emerged and data saturation was achieved. Modified meaning condensation analysis [27,28] was further utilized to formulate thematic questions and accompanying answer statements to systematically categorize the whole range of the specific, gathered knowledge. A set of clustered thematic questions and answer statements was created ( Table 1).…”

“…For the final Delphi round, 13 thematic questions and a varying number of accompanying answer statements were formulated from the gathered data by use of modified meaning condensation analysis. [27,28] Due to data saturation and clarity of statements from the first three Delphi rounds, only six thematic questions and their corresponding answer statements were included in the fourth round. Qualitative and quantitative results are, respectively, displayed in Table 1, Online Resource 1, and in Figs.…”

Experiences of physical activity and exercise in individuals with systemic sclerosis: A qualitative study

“…Responsibilities in daily life have also been reported to interfere with adherence to medications in SSc (Hay & Furst, ). However, low medical treatment adherence rates in SSc (Brijs et al, ) and other rheumatic diseases have been reported (Ritschl et al, ). In SSc, an association between the belief that the disease will be chronic without improvements and poor adherence to treatment has been described (Brijs et al, ; Hay & Furst, ).…”

Real-world questions and concerns about disease-modifying antirheumatic drugs (DMARDs): a retrospective analysis of questions to a medicine call center

“…Safety as a goal of medicines information seeking is supported by consumer medicines information needs literature (39). High fear scores can reduce adherence and potentially impede clinical outcomes (40)(41)(42). In our cohort, most of the callers expressing their fear of taking the medicine resulted from reading the consumer package insert.…”