J Crohns Colitis. 2020 May 7;jjz034. doi: 10.1093/ecco-jcc/jjz034. Online ahead of print.

Sarah Chapman ^1 2, Alice Sibelli ^1 3, Anja St-Clair Jones ⁴, Alastair Forbes ^5 6, Angel Chater ^1 7, Rob Horne ¹

Author information

¹UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.

²Department of Pharmacy & Pharmacology, University of Bath, Bath, UK.

³Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

⁴Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Pharmacy Department, Brighton, UK.

⁵Institute for Digestive Diseases, University College London, London, UK.

⁶Norwich Medical School, University of East Anglia, Norwich, UK.

⁷Centre for Health, Wellbeing and Behaviour Change, Faculty of Education and Sport, University of Bedfordshire, Bedford, UK.

Abstract

Background and aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD].

Methods: Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up.

Results: A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable.

Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence.