Patients' adherence-related beliefs about methotrexate: a qualitative study of the role of written patient information.

Abstract

OBJECTIVES:

Methotrexate is effective in treating inflammatory arthritis, but both underadherence and overadherence can put patients at risk. Patients may fail to adhere due to practicalities including the unusual weekly dosing regimen, but medication beliefs also play a role. This study explored how both beliefs about necessity and concerns about methotrexate become established in patients with inflammatory arthritis and how patients use information in managing their beliefs and concerns.

DESIGN:

Semistructured interviews were conducted with patients taking oral methotrexate for inflammatory arthritis. Interviews were transcribed verbatim and analysed thematically.

SETTING:

Participants were recruited from a single Trust in the East Midlands.

PARTICIPANTS:

Fifteen patients (4 male, 11 female) with inflammatory arthritis.

RESULTS:

Methotrexate was commonly prescribed at the time of diagnosis; at this point, experience of illness was influential for beliefs about medication necessity. Following prescription, patients absorbed information from written and verbal sources which reinforced beliefs about necessity but also raised concerns, including fear of side effects. Over time, beliefs were modified on the basis of personal experience, particularly of medication effectiveness and side effects. Some patients described tensions and dissonance in their beliefs and experiences of methotrexate, which put them at risk of non-adherence. Patients used information-seeking and information-avoidance as strategies to resolve these tensions. The available information did little to help suppress dissonance and sometimes exacerbated it.

CONCLUSIONS:

Patients' experiences of coming to terms with taking methotrexate are complex, and their experiences of dissonance are particularly problematic. Experiences might be improved by supporting patients to assess necessity (particularly in the presence of side effects) and by providing information to moderate unnecessary concerns. Improving recording and sharing of monitoring results may be one way to meet these needs.

• Authors: Charlotte Hayden, Rebecca Neame, Carolyn Tarrant
• Journal: BMJ open (BMJ Open) Vol. 5 Issue 5 Pg. e006918 (May 20 2015) ISSN: 2044-6055 [Electronic] England
• PMID: 25995237 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Antirheumatic Agents
• Methotrexate

Topics

• Adult
• Aged
• Antirheumatic Agents (administration & dosage)
• Arthritis (drug therapy, psychology)
• Female
• Health Knowledge, Attitudes, Practice
• Health Literacy (statistics & numerical data)
• Humans
• Male
• Medication Adherence (psychology, statistics & numerical data)
• Methotrexate (administration & dosage)
• Middle Aged
• Patient Education as Topic
• Qualitative Research