The impact of using musculoskeletal ultrasound imaging and other influencing factors on medication adherence in patients with rheumatoid arthritis: a qualitative study

Figures & data

Table 1 Demographic data of the patients interviewed

	High adherers*	Low adherers*
	n=10	n=10
Sex
Male	3	3
Female	7	7
Language spoken during interviews
English	9	6
Punjabi	1	4
Employment
Employed	4	4
Unemployed	1
Homemaker	2	1
Retired	1	3
Off work due to RA	2	1

Notes: High adherence defined as a MARS of ≥25 (ie, in the upper tertile of responses) and low adherence as a MARS of ≤25 (ie, in the lower tertile of responses).

* ≥25 is the maximum possible score of MARS and 18 was the lowest observed score of MARS in our cross-sectional study.

Abbreviations: MARS, Medication Adherence Rate Score; RA, rheumatoid arthritis.

Figure 1 Topic guide based on SRM-CSM and NCF (questions asked during the interviews).

Abbreviations: CSM, Common Sense Model; DMARDs, disease-modifying antirheumatic drugs; NCF, Necessity–Concerns Framework; RA, rheumatoid arthritis; SRM, Self-Regulatory Model.

Table 2 Comparison of themes and subthemes by adherence level

Themes	High adherers	Low adherers
Symptom severity	• Severe symptoms • Family history of RA	• Mild symptoms
Illness perception	• Patients accept that there is no cure for RA • Patients accept that RA is a long-term disease	• Patients seek for a cure of RA through their treatment • Patients perceive RA to be a short-term disease
Perceived benefits and risks of DMARDs	• Patients’ beliefs about the necessity of DMARDs outweigh their concerns • Patients’ experiences of the beneficial effects of DMARDs in controlling disease activity	• Patients’ concerns about DMARDs outweigh their beliefs about the necessity of DMARDs
The quality and quantity of information	• Satisfaction with information/visual aids • Good relationship with health professionals • Good knowledge about disease parameters	• Lack of information, no experience of visual aids • Poor relationship with health professionals • Poor knowledge about disease parameters
Patients’ suggestions about strategies to optimize adherence to DMARDs	• Visual representations to explain the disease process and to provide objective feedback about the extent to which their disease activity is being effectively controlled • Better explanations of the consequences of poorly controlled RA • A good relationship with the health professional • Access to patient support groups

Abbreviations: DMARDs, disease-modifying antirheumatic drugs; RA, rheumatoid arthritis.