"I Probably Am Being a Naughty Boy, But…" Reasons for Non-Adherence to Prescribed Medication, as Perceived by People Living with Inflammatory Bowel Disease: A Qualitative Study.

Purpose: Inflammatory bowel disease (IBD) is treated with medications to induce and maintain remission. However, many people with IBD do not take treatments as prescribed. Identifying and understanding reasons behind medication non-adherence in IBD is critical. Patients and Methods: Semi-structured interviews were recorded and transcribed verbatim. Braun and Clarke's principles of reflexive thematic data analysis were followed. Results: Twenty people living with IBD were purposively selected and interviewed. Four main themes were identified: 1) Context: adherence was impacted by the context of care individuals received, daily activities, physical and emotional well-being and relationship with others; 2) Battles: with IBD, with healthcare professionals and/or with IBD medication; 3) Medical treatment: treatment type, efficacy, side-effects and treatment requirements influenced adherence, as did an individual's treatment beliefs; and 4) Knowledge, learning, understanding and experience of IBD as a condition and its treatment typically promoted adherence. Yet treatment information was frequently not offered by healthcare professionals, leading individuals to self-educate and develop personal understanding, which with experience, influenced their adherence, both positively and negatively. Conclusion: Medication adherence is a journey, influenced by multiple determinants. IBD diagnosis is a critical stage where individuals require compassionate care from both multidisciplinary health professionals and personal networks. Clear treatment information should be provided, with self-education encouraged through trusted resources. To promote adherence and establish treatment routines, patients must feel fully informed, confident and comfortable in their shared decision-making on treatment that will suit their lifestyle.