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Medication Beliefs, Self-Efficacy Examined in RA

J Rheumatol; ePub 2018 Sep 15; McCulley, et al

In a diverse cohort of patients with rheumatoid arthritis (RA), stronger beliefs in the necessity of medication were associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy was associated with poor adherence. This according to a recent study that that examined the associations among medication beliefs, self-efficacy, and adherence to medications in RA. Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Researchers found:

  • There were 362 patients who reported taking a synthetic DMARD and/or prednisone.
  • Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively.
  • There were 64% who reported concern about taking medicines, 81% about long-term effects, and 47% about becoming too dependent on medicines.
  • Beliefs in medicines and self-efficacy were not associated with adherence to biologics.


McCulley C, Katz P, Trupin L, Yelin EH, Barton JL. Association of medication beliefs, self-efficacy, and adherence in a diverse cohort of adults with rheumatoid arthritis. [Published online ahead of print September 15, 2018]. J Rheumatol. doi:10.3899/jrheum.171339.


Among 362 patients with rheumatoid arthritis (RA) who were participating in observational studies and taking oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, 50 patients said that they had missed ≥1 pills in the last week or ≥1 injections in the last month, in response to a telephone interview. Using self-report questionnaires, 50 non-adherent patients were compared with 312 adherent patients to evaluate factors associated with non-adherence. Patients who believed their RA medications were necessary and helpful were more likely to be adherent. Surprisingly, however, patients with more self-confidence in their ability to control their motivations, behaviors, and environment (ie, greater self-efficacy), were more likely to be non-adherent. The authors suggest that clinicians can help improve patients’ beliefs and perceptions about the need for and value of RA medications, thereby improving their adherence to prescribed regiments.—Harold E. Paulus, M.D.; Emeritus Professor; University of California, Los Angeles; Division of Rheumatology.