title: Identifying individual psychosocial and adherence support needs in patients with psoriasis: a multinational two-stage qualitative and quantitative study.
abstract: BACKGROUND
  Psoriasis has a serious impact on patients' lives. However, adherence to medications is often poor, potentially compounding the burden of disease. Identifying patients who need support with psychosocial problems, or issues with adherence, can be complex.
  
  
  OBJECTIVE
  We aimed to develop statements that could assist the consultation process, identifying the relative importance of factors related to effective management of psoriasis for patients.
  
  
  METHODS
  A two-stage study design was used to comprehensively identify, and assess validity of, statements describing psoriasis impact and management issues. Both components were conducted in Canada, France, Germany, Italy, Spain, the United Kingdom and the United States. Findings from patient observation and interviews were analysed for pattern strength, and were then used to inform the development of statements that were quantitatively assessed using a survey. The association of drivers towards agreement with 'my psoriasis dictates how I lead my life' was assessed using anova.
  
  
  RESULTS
  Fifty-six patients participated in the qualitative component, and 1,884 patients using prescription medications completed the survey. Two thematic categories were identified; disappointment with treatments, and confusion regarding psoriasis associated with a lack of direction. When assessed quantitatively, key statements associated with a strong burden of psoriasis on patients' lives were related to isolation, social stigma, visible symptoms, impact on activities and feelings of hopelessness. A mixture of patient-, doctor- and treatment-related factors were among the most common reasons for non-adherence.
  
  
  CONCLUSIONS
  Questioning using the statements most associated with psychosocial impact and non-adherence could help identify patients with additional support needs, and assist in overcoming adherence issues.
authors.affiliation: Whipps Cross University Hospital & Barts & the London NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bewley
authors.forename: D M
authors.initials: DM
authors.lastname: Burrage
authors.forename: S J
authors.initials: SJ
authors.lastname: Ersser
authors.forename: M
authors.initials: M
authors.lastname: Hansen
authors.forename: C
authors.initials: C
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult