title: Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.
abstract: OBJECTIVE
  To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up.
  
  
  RESULTS
  123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)).
  
  
  CONCLUSIONS
  This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time.
  
  
  CONCLUSIONS
  Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: h.zwikker@maartenskliniek.nl.
authors.forename: Hanneke E
authors.initials: HE
authors.lastname: Zwikker
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
authors.forename: Cornelia H
authors.initials: CH
authors.lastname: van den Ende
authors.affiliation: HAN University of Applied Sciences, Institute of Health Studies, The Netherlands.
authors.forename: Wim G
authors.initials: WG
authors.lastname: van Lankveld
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
authors.forename: Alfons A
authors.initials: AA
authors.lastname: den Broeder
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
authors.forename: Frank H
authors.initials: FH
authors.lastname: van den Hoogen
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
authors.forename: Birgit
authors.initials: B
authors.lastname: van de Mosselaar
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, The Netherlands; Department of Health Science, Buskerud University College, Drammen, Norway.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.affiliation: Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands; Department of Pharmacy, Radboud University Medical Centre, The Netherlands. Electronic address: b.vandenbemt@maartenskliniek.nl.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: van den Bemt
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D062405:Motivational Interviewing; D010353:Patient Education as Topic; D010595:Pharmacists; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: Beliefs about medication; Medication adherence; Motivational interviewing; Randomized controlled trial; Rheumatoid arthritis