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Clinical Rheumatology
Published in: Clinical Rheumatology 1/2021

Open Access 01-01-2021 | Rheumatoid Arthritis | Original Article

A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial

Authors: Shahnaz Asgari, Mahnaz Abbasi, Kyra Hamilton, Yu-Pin Chen, Mark D. Griffiths, Chung-Ying Lin, Amir H. Pakpour

Published in: Clinical Rheumatology | Issue 1/2021

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Abstract

Introduction/objectives

Adherence to prescribed medication regimens is fundamental to the improvement and maintenance of the health of patients with rheumatoid arthritis. It is therefore important that interventions are developed to address this important health behavior issue. The aim of the present study was to design and evaluate a theory-based intervention to improve the medication adherence (primary outcome) among rheumatoid arthritis patients.

Methods

The study adopted a pre-registered randomized controlled trial design. Rheumatoid arthritis patients were recruited from two University teaching hospitals in Qazvin, Iran from June 2018 to May 2019 and randomly assigned to either an intervention group (n = 100) or a treatment-as-usual group (n = 100). The intervention group received a theory-based intervention designed based on the theoretical underpinnings of the health action process approach (HAPA). More specifically, action planning (making detailed plans to follow medication regimen), coping planning (constructing plans to overcome potential obstacles that may arise in medication adherence), and self-monitoring (using a calendar to record medication adherence) of the HAPA has been used for the treatment. The treatment-as-usual group received standard care.

Results

Data analysis was conducted based on the principle of intention to treat. Using a linear mixed-effects model (adjusted for age, sex, medication prescribed, and body mass index), the results showed improved medication adherence scores in the intervention group (loss to follow-up = 16) compared to the treatment-as-usual group (loss to follow-up = 12) at the 3-month (coefficient = 3.9; SE = 0.8) and 6-month (coefficient = 4.5; SE = 0.8) follow-up. Intervention effects on medication adherence scores were found to be mediated by some of the theory-based HAPA variables that guided the study.

Conclusion

The results of the present study support the use of a theory-based intervention for improving medication adherence among rheumatoid arthritis patients, a group at-risk of not adhering to medication regimens.

Trial registration (in Iranian Registry of Clinical Trials)

irct.ir, IRCT201801080382​71N1
Key Points
• Theoretical underpinnings of the health action process approach are useful to improve medication adherence for RA patients.
Appendix
Available only for authorised users
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Metadata
Title
A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial
Authors
Shahnaz Asgari
Mahnaz Abbasi
Kyra Hamilton
Yu-Pin Chen
Mark D. Griffiths
Chung-Ying Lin
Amir H. Pakpour
Publication date
01-01-2021
Publisher
Springer International Publishing
Published in
Clinical Rheumatology / Issue 1/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-020-05224-y

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