Disentangling rheumatoid arthritis patients’ implicit and explicit attitudes towards methotrexate

Up to now, effective adherence interventions are scarce and a more comprehensive model of adherence determinants is required to target determinants for not taking the medication as prescribed. Current approaches only included explicit attitudes such as self-reported evaluations of medication as determinants, neglecting the role of associative processes that shape implicit attitudes. Based on our results, we argue that only addressing explicit attitudes when improving medication adherence might overlook patients who have conflicting attitudes; patients who are explicitly positive but implicitly negative regarding their medication, which constitutes no less than 50 percent of the current patient sample.

Medication non-adherence is a major public health problem that has been termed an ‘invisible epidemic’. Not only is non-adherence associated with negative clinical consequences but it can also result in substantial healthcare costs. Up to now, effective adherence interventions are scarce. To fill this gap a more comprehensive model of adherence determinants is required to target the determinants for not taking the medication as prescribed. However, these models are mostly based on explicit measures. The lack of implicit attitudes could be a reason as of why these models and interventions fail to target medication adherence. We know that in daily and routine behaviors implicit processes can predict daily behavior more accurately than explicit attitudes. Our aim is therefore to assess explicit and implicit attitudes toward medication and explore the relation with beliefs, adherence and clinical (laboratory) outcomes in chronically ill patients. To do so, we measured the attitudes toward Methotrexate (MTX) of the fifty two Rheumatic Arthritis (RA) patients. The attitudes were measured both explicitly (self-reported) and implicitly (Single-Category Implicit Association Test) and related to the Beliefs about Medicine Questionnaire, the Compliance Questionnaire on Rheumatology and clinical outcomes. In short, results show that explicit attitudes were positive and health-related. Implicit attitudes were, however, negative and sickness-related. Half of the patients displayed explicitly positive but implicitly negative attitudes. With this information we can improve our understanding of the subconscious, automatic processes underlying adherence and we can develop interventions that target these implicit attitudes.

More Information? Linn, A. J., Wennekers, A., Vervloet, M., Van Dijk, L., & van den Bemt, B, 2016.”Disentangling rheumatoid arthritis patients’ implicit and explicit attitudes towards methotrexate.” Frontiers in Pharmacology, 7:233.

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Published on 16-08-2016