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Title: Patients’ adherence-related beliefs about methotrexate: a qualitative study of the role of written patient information.
Authors: Hayden, Charlotte
Neame, Rebecca
Tarrant, Carolyn
First Published: 20-May-2015
Publisher: BMJ Publishing Group
Citation: BMJ Open 2015;5:e006918
Abstract: Objectives. Methotrexate is effective in treating inflammatory arthritis, but both under- and over-adherence can put patients at risk. Patients may fail to adhere due to practicalities including the unusual weekly dosing regimen, but medication beliefs also play a role. This study explored how both beliefs about necessity and concerns about methotrexate become established in patients with inflammatory arthritis and how patients use information in managing their beliefs and concerns. Design. Semi-structured interviews were conducted with patients taking oral methotrexate for inflammatory arthritis. Interviews were transcribed verbatim and analysed thematically. Setting. Participants were recruited from a single Trust in the East Midlands. Participants. Fifteen patients (4 male, 11 female) with inflammatory arthritis. Results. Methotrexate was commonly prescribed at the time of diagnosis; at this point experience of illness was influential for beliefs about medication necessity. Following prescription, patients absorbed information from written and verbal sources which reinforced beliefs about necessity but also raised concerns, including fear of side effects. Over time, beliefs were modified on the basis of personal experience, particularly of medication effectiveness and side-effects. Some patients described tensions and dissonance in their beliefs and experiences of methotrexate, which put them at risk of non-adherence. Patients used information-seeking and information-avoidance as strategies to resolve these tensions. Available information did little to help suppress dissonance and sometimes exacerbated it. Conclusions. Patients’ experiences of coming to terms with taking methotrexate are complex, and experiences of dissonance are particularly problematic. Experiences might be improved by supporting patients to assess necessity (particularly in the presence of side effects) and by providing information to moderate unnecessary concerns. Improving recording and sharing of monitoring results may be one way to meet these needs.
DOI Link: 10.1136/bmjopen-2014-006918
ISSN: 2044-6055
eISSN: 2044-6055
Version: Published version (Publisher PDF)
Status: Peer-reviewed
Type: Journal Article
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Appears in Collections:Published Articles, Dept. of Health Sciences

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