Beliefs About Medications in IBD

Abstract

BACKGROUND: Non-adherence to medication is a well-known problem in patients with Inflammatory Bowel Disease, with prevalence rates ranging from 7-77% for oral medications [1], and 17-29% for biologics [2]. Factors such as total daily dose, administration route, psychological problems and younger age have been identified as predictors of non-adherence. In contrast, there is a paucity of information regarding the medication beliefs held by people with IBD. The aim of this study was to investigate the beliefs about medications expressed by patients with IBD, and to investigate if these beliefs were associated with fatigue, depression, anxiety, and self-efficacy. METHODS: Patients from nine hospital outpatient clinics in Norway, were recruited as part of the 1-Year follow-up of the Vitality-study [3]. The Belief about Medicines Questionnaire (BMQ-specific) was used, consisting of two 5-item scales assessing patients' beliefs about the necessity of medication and their concerns about potential adverse effects of taking it. The score range is 5-25, where a higher score indicates higher necessity beliefs or more medication concerns, respectively. Fatigue was measured with the Fatigue Questionnaire (FQ), including both physical (PF), mental (MF) and total (TF) fatigue. A higher score indicates more fatigue. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS-A and D). Higher HADS score indicate increased symptoms. Self-efficacy was measured using the General Perceived Self-Efficacy Scale (GSE), where a lower score indicates lower self-efficacy. RESULTS: A total of 67% (274/410) of the original Vitality-study cohort agreed to participate at the one-Year follow-up, of which 94% (257/274) had evaluable data on all outcome measures. Mean BMQ necessity score was 18.5 (SD 4.3, range 5-25), while mean BMQ-concern score was 12.4 (SD 4.1, range 5-23). Increased HADS-D and physical fatigue were negatively associated with BMC necessity (P<0.001 and P<0.05, respectively). BMQ-concern was higher in patients with lower self-efficacy scores (P<0.001) higher HADS-A scores (P<0.001) and mental fatigue scores (P<0.05). Total fatigue scores were not associated with neither BMQ necessity nor concern. CONCLUSION(S): In this study, we observed that IBD patients had generally low concerns about their prescribed medication, as well as a high belief in the necessity of these medications. Increased concern was associated with increased anxiety and fatigue scores as well as decreased self-efficacy. A decreased belief in the necessity of IBD medication was associated with increased depression and physical fatigue. Addressing these beliefs through a patient-centered approach in clinical follow-up may potentially also optimise patient adherence to medical treatment in IBD.