Factors affecting medication adherence in rheumatoid arthritis.

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease that typically affects the wrists and small joints of the hands and feet. Its progressive nature can result in severe deformities and the inability to perform daily tasks. RA requires lifelong medication to ameliorate symptoms of the disease. The lifestyle changes necessary to achieve continuing functionality include taking medication daily. This is an area that has not been adequately researched.

Aim: To qualitatively determine the factors affecting RA patients’ adherence to chronic prescribed medication.

Methods: A semi-structured interview schedule was used to interview 18 patients from an out-patient Rheumatology Clinic at a Johannesburg hospital. The patients were purposively selected and invited to participate in the study. The individual interviews were conducted in the home language of the participant and video-recorded. Interview were then translated into English and transcribed. The patient accounts of their medication taking habits were compared to their hospital records regarding prescribed medication. Thematic Analysis was used to identify the prominent issues raised in each interview. These categories were then grouped into themes that occurred across the data set. Interviews with two members of staff and ethnographic observations were also conducted to get a better understanding of how the clinic functions.

Findings: Four main themes were identified. Firstly, the effect of RA on the living experiences of patients. This dealt with the manner in which RA affected their quality of life and how those experiences affected adherence. Secondly, interactions with medication, which explored the manner in which patients used both prescribed and non-prescribed medication. Thirdly, patients’ experience of healthcare services. This explored the functioning of health systems and how patient adherence can be subsequently affected. Lastly, level of understanding and access to information which explored the effect of the knowledge deficit that exists in patients regarding biomedical concepts and how that contributes to their adherence levels.

Discussion: The findings showed that more can still be done by healthcare professionals to improve patients’ experience of the healthcare system, and to promote patient adherence to medication. The factors that affect adherence provide many avenues for further research, areas in which interventions can be implemented to improve the quality of healthcare being provided to South African communities.