Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis

Abstract

SummaryBackgroundMedication nonadherence is known to limit the effectiveness of available therapies; however, little is known specifically about medication adherence in people with psoriasis. Medicines self‐management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing nonadherence to medication as an outcome of limited personal coping resources and conflicting goals may help to explain medication nonadherence.ObjectivesTo explore individuals’ perspectives of their psoriasis, medication and its management.MethodsTwenty people with psoriasis were recruited from community samples in England and interviewed in‐depth about their perceptions of their psoriasis, medication, and adherence to medication and self‐management advice. Data were analysed using Framework Analysis.ResultsParticipants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self‐reported adherence, which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants’ self‐management difficulties was viewed as an additional source of stress and distress.ConclusionsAdhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of nonadherence to psoriasis medication as rational attempts by individuals to minimize distress and to gain control over their life.

Health-related quality of life in adolescents with psoriasis: an interview-based study

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“…To provide optimal care for adolescent patients with psoriasis, dermatologists are recommended not only to focus on physical symptoms, but also to pay attention to the psychosocial aspects of living with psoriasis . The degree to which dermatologists succeed in this is debated and challenged by the scarcity of research on the specific content and importance of such impairments in daily life. We hope that the conceptual model developed in our study will support dermatologists in providing optimal care for adolescents with psoriasis by inviting them to stay alert regarding the many specific HRQoL challenges identified in the present study.…”

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“…Secondly, although tempting to think that we improve this with a mixture of persuasion, encouragement and warnings, we need to open our minds to understanding poor compliance. Thorneloe et al 6 have shown that the reasons behind nonadherence are complicated and subtle. Their detailed interviews with 20 patients with psoriasis revealed the reality, and often impossibility, of trying to integrate regular therapy with their daily lives.…”