What Drives Medication Adherence—or Nonadherence—in Crohn’s Disease?

Approximately 40% of patients with Crohn’s disease (CD) do not adhere to their prescribed regimens with immune-modifying medications, according to a recent study. As a result, these patients are at higher risk of complications, hospitalization, and surgeries.

Investigators set out to identify the factors that contribute to adherence or nonadherence with medication recommendations for CD. They conducted qualitative interviews using semistructured interview guides with patients who had a diagnosis of CD and were identified as adherent or nonadherent to their physicians’ recommendations for immune-modifying medication. The team analyzed the resulting qualitative data using an inductive-deductive approach to identify emergent themes that influence medication decision-making.

Two broad domains emerged for the 25 completed interviews of patients with CD. “Adherent patients conveyed a sense of trust in science and expertise, while nonadherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment,” the authors wrote.

“There are clear cognitive, behavioral, and relational factors that guide patients’ medication-related decision-making,” they added. “Several of the factors share features of other behavioral change and decision-making processes, while others are specific to the experience of patients with CD. A fuller understanding of these factors is essential to developing effective behavioral interventions to improve adherence to evidence-based treatment recommendations.”

Brady RE, Salwen-Deremer JK, Tunnell NC, Winter MW. Understanding medication nonadherence in C disease patients: a qualitative evaluation. Inflamm Bowel Dis. 2024;30(11): 2046–2056, https://doi.org/10.1093/ibd/izad296