Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Impact of Health Beliefs on Therapeutic Adherence in Patients with Rheumatoid Arthritis (RA).

Rizvi1,  Tara J., Gomez1,  John, Achaval2,  Sofia de, Kallen2,  Michael A., Cox2,  Vanessa L., Richardson2,  Marsha N., Ng1,  Bernard

Baylor College of Medicine, Houston, TX
The University of Texas M. D. Anderson Cancer Center, Houston, TX
Univ Texas Health Sci Ctr, Houston, TX
University of Texas, MD Anderson Cancer Center, Houston, TX

Objective:

To determine whether the health beliefs of persons with RA influence their adherence to planned treatment.

Methods:

We ascertained a cohort of patients with RA followed at publicly funded hospitals in Houston, TX. Eighteen specific components of the health belief model (HBM), including perceived severity and susceptibility, perception of self efficacy, benefits and risks of treatment, and barriers to treatment were measured using a self-report questionnaire. Treatment adherence was assessed with a previously validated questionnaire used in patients with rheumatic disease: de Klerk's Compliance Questionnaire Rheumatology (CQR). Pearson correlations between HBM components at baseline and CQR at baseline and 24 months were calculated. Stepwise linear regression modeling to predict adherence was then conducted, using HBM components that were statistically significantly (p<.05) correlated with adherence; select demographic and clinical patient characteristics such as age, gender, education level, and disease duration, were included in the modeling.

Results:

201 patients with RA were included: 75% were female; mean age was 51 years; 172 patients completed the 24 month follow-up. Ten of 18 HBM components ascertained were significantly related to treatment adherence at baseline and/or 24 months (Table 1). HBM components with a negative impact on treatment adherence were: belief in natural remedies, barriers in access to care, barriers due to beliefs about medication side effects, and beliefs about therapeutic lack of efficacy of RA therapies. Positive correlations with treatment adherence were observed with the following HBM components: belief in treatment benefits, belief in traditional medical treatment benefits, and positive attitudes towards risks of treatment. In the multi-variable regression analysis, belief in benefits of traditional treatment, willingness to take more risk, and longer disease duration were independent predictors of increased baseline treatment adherence, while higher levels of forgetting, financial barriers, and side effects were independent predictors of decreased adherence.

Table 1. Pearson Correlations of HBM Components with de Klerk Adherence (CQR)

HBM ComponentCQR BaselineCQR 24 Months
Perceived Severity/Susceptibility.20*0.14
Perceived Threat0.11.21*
Self Efficacy-Pain-.15*-0.09
Self Efficacy-Function0.010.04
Self Efficacy-Symptoms-0.030.03
Self Efficacy-Optimism.20*.17*
Health Beliefs & Attitudes0.1.18*
Risk Items.34*.24*
Benefits Traditional Remedies.35*.21*
Benefits of Treatment.26*.26*
Natural Remedies-.19*-.18*
Barriers Scheduling-.22*-0.13
Barriers Transportation-.21*-0.13
Barriers Clinic-0.13-.19*
Barriers Financial-.29*-.20*
Barriers Forget-.46*-.37*
Barriers Side Effects-.33*-.41*
Barriers Inefficacy-.30*-.30*
*p <.05.

Conclusion:

A number of patient perceptions and beliefs impact therapeutic adherence in patients with RA. Based on our findings, strategies to improve adherence may include interventions to positively modify patients' beliefs regarding treatment benefits and side effects, and to limit modifiable barriers leading to non-adherence.

To cite this abstract, please use the following information:
Rizvi, Tara J., Gomez, John, Achaval, Sofia de, Kallen, Michael A., Cox, Vanessa L., Richardson, Marsha N., et al; The Impact of Health Beliefs on Therapeutic Adherence in Patients with Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :87
DOI: 10.1002/art.27856

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