Background/Purpose: Disappointing and inconsistent findings of adherence intervention research in inflammatory arthritis (IA) highlight the need for further work in designing interventions that promote and support treatment adherence. Patient-centered approaches to developing medication adherence interventions have shown promise in other chronic diseases, and may be particularly relevant in IA where they have scarcely been applied. We aimed to explore IA patients’ perspectives on strategies to support medication adherence.  

Methods: Individuals were eligible for the study if they: (1) had a rheumatologist-confirmed diagnosis of IA, (2) were taking a DMARD(s), and (3) could communicate in English. A novelty of our study, an experienced facilitator led participants through a group exercise where participants were asked to design a hypothetical tool(s)/aid(s) supporting medication use. Participants developed their tools individually using provided activity sheets and coloured cards corresponding to features of their tools, including (1) what (is your tool?), (2) how (does your tool work?), and (3) who (is there anybody who uses your tool with you?). They were then invited to share their tools with the group, and the facilitator used open-ended questions to promote discussion. In our qualitative analysis, we applied an iterative, thematic approach informed by aspects of grounded theory and using the constant comparison method. Three study team members independently read and annotated the transcripts, and after discussion agreed on an initial coding framework. Categories emerging from the focus groups were identified and collected under major thematic headings.

Results: Six focus groups were held with 4-6 participants each. Qualitative analyses resulted in the identification of three predominant emerging themes: (1) educational resources; (2) lifestyle modifications and adaptations; and (3) the journey of medication use. Educational resources encompassed communication with a healthcare provider (e.g., rheumatologist, pharmacist), patient group classes, pamphlets and written resources, eHealth/mHealth, and learning about medication side-effects. Lifestyle modifications and adaptations were comprised of physical reminders/prompts for medication use (e.g., blister packs, pill boxes), electronic alerts/reminders (e.g., smartphone apps), establishing a routine (e.g., taking medication with breakfast), and managing multiple medications. The journey of medication use encompassed the sequential process of patients learning about and gaining confidence in prescribed medications, and the subsequent integration of these medications into their daily life (“Once I know the med, once I’m confident in the med, it’s working, then I phase it into my lifestyle”).

Conclusion: To our knowledge, this is the first study to use a novel group exercise to explore patients’ perspectives on strategies to support medication use in IA. Both educational resources and lifestyle modifications/adaptations were paramount to medication use among IA patients. These findings have important implications for the development of patient-centered medications adherence interventions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflammatory-arthritis-patient-perspectives-on-strategies-to-support-medication-adherence-a-qualitative-study-using-a-novel-group-exercise/