N10 “I probably am being a naughty boy, but…” Exploring reasons for non-adherence to prescribed medication, as perceived by people living with Inflammatory Bowel Disease: A Qualitative Study
Authors: King K , Norton C , Chalder T , Czuber-Dochan W 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take treatments as prescribed. Identifying and understanding reasons behind medication adherence and non-adherence in IBD is critical.

Methods
In-depth, semi-structured interviews were audio or video-recorded and transcribed verbatim. Braun and Clarke’s (Braun & Clarke, 2006) principles of thematic data analysis were followed to analyse data.

Results
Twenty people living with IBD were purposively selected and interviewed. Four main themes were identified (Table1) with related sub-themes; 1) The Context within which adherence needs to happen 2) Battles throughout the IBD “journey” 3) Multiple medical treatment issues and 4) Knowledge, learning, understanding and experience of IBD as a condition and its treatment.
From diagnosis and throughout their IBD “journey,” medication adherence in many participants was variable. Adherence was impacted by the context of healthcare received by individuals, their daily activities, physical and emotional well-being and relationships with others. Participants regularly described themselves as experiencing a battle using intense terms such as battling with their IBD, their healthcare professionals (HCPs) and/or their IBD medication. Treatment type (including drug category, for example steroids or immunosuppressants, associated risks and side effects), treatment effectiveness and requirements for taking it, all influenced adherence, as did an individual’s treatment values and beliefs. Gaining knowledge, developing understanding regarding medication and its necessity from the start of diagnosis was critical for adherence. This had strong potential to impact adherence positively and/or negatively, based upon what participants were told, when, and by whom. Yet, treatment information was frequently not offered by HCPs, leading individuals to self-educate and develop a personal understanding of their condition and medication. This, combined with the experiencing of living with IBD, influenced their adherence.

Conclusion
Medication adherence is a journey, affected by multiple determinants. Determinants may be patient-centred, influenced by HCPs and/or determined by an individual’s knowledge and experience level. Diagnosis is a critical stage where individuals require compassionate care from their personal networks and multidisciplinary HCPs. Clear medical treatment information should also be provided by HCPs, with self-education encouraged via trusted resources. To promote adherence and establish treatment routines, patients must feel fully informed, supported, confident and comfortable in their shared decision-making about treatment, that will suit their lifestyle.

References
-Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77-101