title: Determinants of adherence to disease modifying anti-rheumatic drugs in White British and South Asian patients with rheumatoid arthritis: a cross sectional study.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disability, and reduced life expectancy. Highly effective drugs are now available for the treatment of RA. However, poor adherence to drug regimens remains a significant barrier to improving clinical outcomes in RA. Poor adherence has been shown to be linked to patients' beliefs about medicines with a potential impact on adherence. These beliefs are reported to be different between ethnic groups. The purpose of this study was to identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including an assessment of the influence of beliefs about medicines and satisfaction with information provided about DMARDs and compare determinants of adherence between RA patients of White British and South Asian.
  
  
  METHODS
  RA patients of either White British (n = 91) or South Asian (n = 89) origin were recruited from secondary care. Data were collected via questionnaires on patients': (1) self-reported adherence (Medication Adherence Report Scale-MARS); (2) beliefs about medicines (Beliefs about Medicines Questionnaire-BMQ); (3) illness perceptions (Illness Perceptions Questionnaire-IPQ) and (4) satisfaction with information about DMARDs (Satisfaction with Information about Medicines questionnaire-SIMS). In addition, clinical and demographic data were collected.
  
  
  RESULTS
  The results revealed that socio-demographic factors only explained a small amount of variance in adherence whereas illness representations and treatment beliefs were more substantial in explaining non-adherence to DMARDs. Patients' self-reported adherence was higher in White British than South Asian patients (median 28 (interquartile range 26-30) vs median 26 (interquartile range 23-30) respectively; P = 0.013, Mann-Whitney test). Patients who reported lower adherence were more dissatisfied with the information they had received about their DMARDs (P < 0.001, Spearman correlation, SIMS action and usage subscale; P < 0.001, Spearman correlation, SIMS potential problems subscale) and had more negative beliefs about their DMARDs and were related to ethnicity with South Asian patients having more negative views about medicines.
  
  
  CONCLUSIONS
  Socio-demographic factors were found to explain a small amount of variance in adherence. Illness representations and treatment beliefs were more important in explaining non-adherence to DMARDs. Clinicians managing South Asian patients with RA need to be aware that low adherence may be linked to negative beliefs about medicines and illness representations of RA.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom. k.kumar@bham.ac.uk.|Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, United Kingdom. k.kumar@bham.ac.uk.|University of Manchester, Faculty of Medical and Human Sciences, Manchester, M13 9PL, United Kingdom. k.kumar@bham.ac.uk.
authors.forename: Kanta
authors.initials: K
authors.lastname: Kumar
authors.affiliation: Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, United Kingdom.|Institute of Inflammation and Aging, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom.
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.affiliation: The Wolfson Building, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.affiliation: Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.affiliation: Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chapman
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, United Kingdom.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000208:ethnology* / Q000523:psychology; D044466:Asian People / Q000208:ethnology* / Q000523:psychology; D003430:Cross-Sectional Studies; D004739:England / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011795:Surveys and Questionnaires; D044465:White People / Q000208:ethnology* / Q000523:psychology
chemical_list: D018501:Antirheumatic Agents