Understanding Medication Nonadherence in Crohn's Disease Patients: A Qualitative Evaluation

Inflamm Bowel Dis. 2023 Dec 22:izad296. doi: 10.1093/ibd/izad296. Online ahead of print.

Abstract

Background: Immune-modifying medications are widely available and recognized as valuable by most gastroenterologists. However, approximately 40% of patients with Crohn's disease (CD) do not comply with regimens using these medications, resulting in complications, hospitalization, and surgeries. We sought to identify factors that motivate adherence or nonadherence with medication recommendations for CD.

Methods: We conducted qualitative interviews with patients living with CD who were identified as adherent or nonadherent to immune-modifying medication recommendations by their treating gastroenterologist. Semistructured interview guides were developed based on an established framework for understanding health behaviors. We conducted content analysis of the resulting qualitative data using an inductive-deductive approach to identify emergent themes that influence medication decision-making.

Results: Twenty-five patients with CD completed interviews for this study. Interviews were independently coded and analyzed for thematic content. Two broad domains emerged comprising (1) themes reflected in the Theoretical Domains Framework and (2) novel themes specific to medication decision-making in CD. Adherent patients conveyed a sense of trust in science and healthcare provider expertise, while nonadherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment.

Conclusions: There are clear cognitive, behavioral, and relational factors that guide patients' medication-related decision-making. Several of the factors share features of other behavioral change and decision-making processes, while others are specific to the experience of patients with CD. A fuller understanding of these factors is essential to developing effective behavioral interventions to improve adherence to evidence-based treatment recommendations.

Keywords: Crohn’s disease; Theoretical Domains Framework; biologic medications; immune-modifying medication; medication adherence; patient-provider relationship.

Plain language summary

This study identified the determinants of medication adherence in a sample of patients receiving treatment for Crohn’s disease. A total of 13 determinants across 2 domains were identified as contributing to patient decisions regarding the use of immune-modifying medications.