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4 major causes of nonadherence to RA treatment

Stephen Padilla
01 Aug 2017

Patients with rheumatoid arthritis (RA) in Singapore cite several reasons for nonadherence to treatment, and many of them report more than one reason, which is in line with the multifactorial World Health Organization conceptual framework of adherence, according to a study.

“[W]e have identified four common reasons for nonadherence to RA treatment from the patients’ perspective in Singapore: forgetfulness, low perceived need for treatment, side effects and intentional delay in treatment due to busyness,” researchers said.

A total of 26 patients were included in the study, of whom seven reported nonadherence to medication, two reported nonadherence to doctors’ appointments, and 11 reported nonadherence to both. [Proceedings of Singapore Healthcare 2017;26109-113]

The most common reasons given by patients for nonadherence were forgetfulness (n=13), low perceived need for treatment (n=10), actual or perceived medication side effects (n=6) and intentional delay due to busyness (n=4). Of the participants, 11 reported having more than one of these reasons for nonadherence.

Previous studies also identified forgetfulness as one of the major causes of nonadherence. [Behav Med 2007;32:127–134; Health Psychol 2007;26:40–49; Can J Psychiatry 2006;51:719–722; Am J Med 1997;102:43–49; Am J Cardiol 1993;72:68D-74D]

“Interestingly, despite strong evidence of the advantages of medication pillboxes, usage among participants was low, possibly due to negative stereotype of pillboxes as an aid for the elderly or babies but not for adults,” researchers said. [Diabetes Care 2006;29:1997–2002]

For participants who cited busyness as a reason, this emphasized the potential risk of nonadherence among the working population, particularly those with a busy work schedule or a busy lifestyle, according to researchers.

In the case of those with a low perceived need for treatment, “participants revealed a tendency to associate RA mainly with the experience of pain,” researchers said. “Having little or no pain was perceived as an improvement in the patient’s RA or even as complete recovery, and the need for continued treatment was thus not perceived as being essential.”

Previous studies also revealed that “patients would not take medication deemed unnecessary, and being able to function with the lowered dosage is perceived as an indicator of improved condition.” [Br J Gen Pract 1994:44;465–468; Soc Sci Med 1985:20;29–37]

Finally, researchers said that some participants were not informed about the side effects of RA treatment. Being unaware of the possibility of side effects from medication might have alarmed patients when these first occurred, prompting them to omit medication.

“Based on the reasons for nonadherence, effective intervention strategies can be formulated to improve patients’ adherence to treatment which would consequently result in better treatment outcomes,” researchers said.

“Insights provided by participants in this study can also form the basis of a screening questionnaire to classify patients based on the reasons for nonadherence and design targeted interventions accordingly,” they added.

In this study that sought to explore common reasons for nonadherence to RA treatment, researchers invited patients diagnosed with RA for ≥1 year being followed at the Singapore General Hospital and meeting predefined criteria of nonadherence to participate in focus group discussions. Each focus group was homogenous in terms of gender, language spoken and ethnicity. The investigators audio recorded and subsequently transcribed verbatim the discussions for thematic analysis.

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