What influences adherence to treatment in people with multiple sclerosis?

Moloney, Clare Helen

Abstract

Background
Currently, there are a number of disease modifying therapies (DMTs) available that can help to reduce the number of attacks experienced in relapsing remitting multiple sclerosis (RRMS). However, optimal outcomes are not always achieved due to early treatment discontinuation and low levels of overall adherence. This study sought to understand the drivers of non-adherence from a patient perspective and their potential to be modified through behaviour change interventions.

Methods
A two-part scoping review was carried out to determine the drivers of adherence in people with MS and to explore how these drivers are currently being addressed through adherence interventions. The COM-B framework for adherence and BCT Taxonomy were used to operationalize these findings. Following this review, it was evident that there was a lack of qualitative research exploring drivers of adherence from the perspective of the patient themselves. Therefore a multi-country, qualitative study was conducted. Semi-structured interviews were conducted with 24 (n=12 females) people with RRMS from Germany, Spain and the United Kingdom. Insights were extracted using Framework Analysis.

Findings
The review identified over sixty discrete factors, across thirty-three studies, which had been found to potentially influence adherence behaviours in MS. Twenty-nine of these were identified more than once and 48% could be mapped to the COM-B model of adherence. The review also identified four successful behaviour change interventions that targeted eight of these factors. The qualitative research determined that control and conflict were the overarching themes related to adherence, whereby an increased sense of control over MS and limited conflicts with self-management behaviours and ‘day to day’ life could enhance likelihood and ability to adhere to treatment and other self-management tasks, thereby leading to potentially better outcomes.

Conclusion
Overall, this research found a disconnect between the majority of studies exploring drivers of adherence in MS, and the interventions which have successfully impacted adherence behaviours in the same population. A focus on ‘convenience’ data, in particular clinical and demographic factors, has done little to further our understanding in terms of how best to support this population and there is an apparent need for research exploring drivers of adherence to align more closely with intervention research. This is further supported by the qualitative research that showed the often complex interplay between multiple factors and adherence outcomes in people with MS.

Citation

Moloney, C. H. What influences adherence to treatment in people with multiple sclerosis?. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/850513

• Thesis Type: Thesis
• Publicly Available Date: Jun 6, 2019
• Public URL: https://uwe-repository.worktribe.com/output/850513
• Award Date: Mar 18, 2019