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. 2024 Feb;33(2):137-144.
doi: 10.1177/09612033231225843. Epub 2024 Jan 2.

A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients

Shannon Herndon  1 , Amy Corneli  1   2   3 , Carrie Dombeck  2 , Teresa Swezey  2 , Megan Eb Clowse  1 , Jennifer L Rogers  1 , Lisa G Criscione-Schreiber  1 , Rebecca E Sadun  1 , Jayanth Doss  1 , Amanda M Eudy  1 , Hayden B Bosworth  1   2 , Kai Sun  1
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A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients

Shannon Herndon et al. Lupus. 2024 Feb.

Abstract

Objective: Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to identify factors that enable adherence to immunosuppressive medications among patients with SLE from racial and ethnic minority groups.

Methods: Using a qualitative descriptive study design, we conducted in-depth interviews with purposefully selected (1) patients with SLE from racial and ethnic minority groups who were taking immunosuppressants and (2) lupus providers and staff. We focused on adherence facilitators, asking patients to describe approaches supporting adherence and for overcoming common adherence challenges and providers and staff to describe actions they can take to foster patient adherence. We used applied thematic analysis and categorized themes using the Capability, Opportunity, Motivation, Behavior (COM-B) model.

Results: We interviewed 12 patients (4 adherent and 8 nonadherent based on medication possession ratio) and 12 providers and staff. Although each patient described a unique set of facilitators, patients most often described social support, physical well-being, reminders, and ability to acquire medications as facilitators. Providers also commonly mentioned reminders and easy medication access as facilitators as well as patient education/communication and empowerment.

Conclusion: Using an established behavioral change model, we categorized a breadth of adherence facilitators within each domain of the COM-B model while highlighting patients' individual approaches. Our findings suggest that an optimal adherence intervention may require a multi-modal and individually tailored approach including components from each behavioral domain-ensuring medication access (Capability) and utilizing reminders and social support (Opportunity), while coupled with internal motivation through improved communication and empowerment (Motivation).

Keywords: Systemic lupus erythematosus; behavior; healthcare disparities; immunosuppressive agents; medication adherence; qualitative research.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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References

    1. Mehat P, Atiquzzaman M, Esdaile JM, et al. Medication Nonadherence in Systemic Lupus Erythematosus: A Systematic Review. Arthritis Care Res (Hoboken) 2017; 69: 1706–1713. 20170921. DOI: 10.1002/acr.23191. - DOI - PubMed
    1. Pryor KP, Barbhaiya M, Costenbader KH, et al. Disparities in Lupus and Lupus Nephritis Care and Outcomes Among US Medicaid Beneficiaries. Rheum Dis Clin North Am 2021; 47: 41–53. 20201029. DOI: 10.1016/j.rdc.2020.09.004. - DOI - PMC - PubMed
    1. Feldman CH, Hiraki LT, Liu J, et al. Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000–2004. Arthritis Rheum 2013; 65: 753–763. DOI: 10.1002/art.37795. - DOI - PMC - PubMed
    1. Cooper GS, Parks CG, Treadwell EL, et al. Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States. Lupus 2002; 11: 161–167. DOI: 10.1191/0961203302lu161oa. - DOI - PubMed
    1. Costenbader KH, Desai A, Alarcon GS, et al. Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006. Arthritis Rheum 2011; 63: 1681–1688. DOI: 10.1002/art.30293. - DOI - PMC - PubMed