Review for 10.1186/1471-230X-7-20 (2007)

Reviewer's report 
 Medication beliefs in inflammatory bowel disease patients reporting low quality of life: a qualitative Title: 
study 
 1  18 January 2007 Version: Date: 
 roger jones Reviewer: 
Reviewer's report: 
General 
This paper addresses an area of considerable importance, that of adherence to medication in inflammatory bowel disease. It reports a well-designed and well-conducted qualitative study, rigorously analysed and 
well-presented. I have some concerns which relate to the characterisation of the sample of patients studied 
and the interpretation of the data collected, as well as some minor comments on presentation. 
First of all, however, I think it is about time to get rid of the phrase ‘medication related behaviour’. It is a truly 
awful phrase and should surely be replaced by ‘medicine taking’. 
The background to the study is well and concisely described. 
On p.4, the account of the characteristics of the participants is a little thin and although the duration of 
disease, disease severity and basic demographics are given, it would be helpful to know something about 
the medicine-taking patterns of these patients in terms of adherence to medication and, perhaps, something 
about the frequency of relapse and the time of last relapse – it is possible that these factors might have 
some implication on the patients’ views of medicine, with recency of successful treatment of relapse 
perhaps strengthening beliefs in the utility of medication and vice versa. 
The section on analysis was, I thought, particularly strong, although the authors ought to state who did the 
interviews and who did the analysis – at the top of p.5 the phrase ‘both researchers’ begs this question. 
The results section is generally well-presented, and the use of quotes in the text and in boxes is effective. 
There are some minor spelling and punctuation errors, notably stematil (sic) on p.10, where the proprietary name for Stemetil as well as Imodium should be given, and also on p.11, where there are two spellings for 
azathioprine. 
I thought the discussion was adequate as far as it went, but it could have gone further. Incidentally, on p.13 
to say that the importance of health beliefs is well recognised ‘within the health psychology literature’ is 
rather tantologous - surely it is simply well recognised. 
My main problem with the interpretation of these data is simply that it is too patient-centred. Of course 
physicians should listen to patients, but patients also have to listen to physicians, and there is a strong 
educational message here, telling clinicians involved in the care of IBD what they should themselves be 
telling patients about the risks and benefits of the drugs that they are prescribed and the balances between them. Prescribing isn’t just a matter of listening to patients’ concerns. 
I think that the clinical implications of this go beyond a ‘patient-centred’ approach to treatment, but included 
shared care and genuine self-care of IBD (and of course other common diseases). There is a growing literature, beginning with the Manchester RCT, showing that well-supported shared care in IBD leads to 
better health outcomes and less medical contacts, and adequate patient education about their medication is 
critical in achieving this. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1. Extend description of study population (p4) 2. Say who carried out the interviews (p5) 3. Extend discussion of implications of the findings (pp 14-15) 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 
1. Spelling/punctuation errors (pp10-11) 2. Health beliefs sentence (p13) 
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Discretionary Revisions (which the author can choose to ignore) 1. “Medication related behaviour” (throughout) 
 Unable to decide on acceptance or rejection until the authors have responded to the major What next?: 
compulsory revisions 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.