title: Barriers and facilitators to disease-modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study.
abstract: Although disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of treatment for inflammatory rheumatic diseases, medication adherence to DMARDs is often suboptimal. Effective interventions to improve adherence to DMARDs are lacking, and new targets are needed to improve adherence. The aim of the present study was to explore patients' barriers and facilitators of optimal DMARD use. These factors might be used as targets for adherence interventions.
  
  
  
  In a mixed method study design, patients (n = 120) with inflammatory arthritis (IA) completed a questionnaire based on an existing adapted Theoretical Domains Framework (TDF) to identify facilitators and barriers of DMARD use. A subgroup of these patients (n = 21) participated in focus groups to provide insights into their facilitators and barriers. The answers to the questionnaires and responses of the focus groups were thematically coded by three researchers independently and subsequently categorized.
  
  
  
  The barriers and facilitators that were reported by IA patients presented large inter-individual variations. The identified barriers and facilitators could be captured in the following domains based on an adapted TDF: (i) knowledge, (ii) emotions, (iii) attention, memory, and decision processes, (iv) social influences, (v) beliefs about capability, (vi) beliefs about consequences, (vii) motivation and goals, (viii) goal conflict, (ix) environmental context and resources, and (x) skills.
  
  
  
  Patients with IA have a variety of barriers and facilitators with regard to their DMARD use. All of these barriers and facilitators could be categorized into adapted domains of the TDF. Interventions that address individual facilitators and barriers, based on capability, opportunity, and motivation, are needed to develop strategies for medication adherence that are tailored to individual patient needs.
authors: Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. m.j.h.voshaar@utwente.nl.
authors: Marieke
authors: M
authors: Voshaar
authors: Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
authors: Johanna
authors: J
authors: Vriezekolk
authors: NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.|Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.|Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway.
authors: Sandra
authors: S
authors: van Dulmen
authors: Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.|Department of Pharmacy, Radboudumc, Nijmegen, The Netherlands.|Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Bart
authors: B
authors: van den Bemt
authors: Arthritis Center Twente, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands.
authors: Mart
authors: M
authors: van de Laar
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000523:psychology*; D001288:Attention; D003430:Cross-Sectional Studies; D003657:Decision Making; D004644:Emotions; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008568:Memory; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: Adherence; Disease modifying anti rheumatic drugs; Inflammatory arthritis; Medication adherence; Non-adherence; Rheumatoid arthritis; Theoretical Domains Framework