title: Patients' adherence-related beliefs about methotrexate: a qualitative study of the role of written patient information.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Semistructured interviews were conducted with patients taking oral methotrexate for inflammatory arthritis. Interviews were transcribed verbatim and analysed thematically.
  
  
  METHODS
  Participants were recruited from a single Trust in the East Midlands.
  
  
  METHODS
  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.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hayden
authors.affiliation: Department of Rheumatology, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Neame
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Tarrant
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D010353:Patient Education as Topic; D036301:Qualitative Research; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: QUALITATIVE RESEARCH; RHEUMATOLOGY; THERAPEUTICS