Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis.
BACKGROUND
Medication nonadherence is known to limit the effectiveness of available therapies; however, little is known specifically about medication adherence in people with psoriasis. Medicines self-management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing nonadherence to medication as an outcome of limited personal coping resources and conflicting goals may help to explain medication nonadherence.


OBJECTIVE
To explore individuals' perspectives of their psoriasis, medication and its management.


METHODS
Twenty people with psoriasis were recruited from community samples in England and interviewed in-depth about their perceptions of their psoriasis, medication, and adherence to medication and self-management advice. Data were analysed using Framework Analysis.


RESULTS
Participants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self-reported adherence, which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants' self-management difficulties was viewed as an additional source of stress and distress.


CONCLUSIONS
Adhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of nonadherence to psoriasis medication as rational attempts by individuals to minimize distress and to gain control over their life.
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.
R J
RJ
Thorneloe
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|Salford Royal NHS Foundation Trust, Manchester, U.K.
C
C
Bundy
Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|Salford Royal NHS Foundation Trust, Manchester, U.K.
C E M
CE
Griffiths
Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.
D M
DM
Ashcroft
School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.|Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, U.K.
L
L
Cordingley
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001685:Biological Factors / Q000627:therapeutic use*; D003220:Conflict, Psychological; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology*; D012008:Recurrence; D000068356:Self-Control; D013315:Stress, Psychological / Q000209:etiology; D055815:Young Adult; D016903:Drug Monitoring
D001685:Biological Factors; D003879:Dermatologic Agents
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