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Title: Investigating medication adherence in psoriasis : exploring the role of illness perceptions, medication beliefs, and emotional distress
Author: Thorneloe, Rachael Jane
ISNI:       0000 0004 5993 799X
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2014
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Objectives: Psoriasis is a long-term inflammatory condition associated with considerable psychological and social morbidity. There are multiple psoriasis treatment modalities and regimens making medication adherence particularly demanding. The Self-Regulatory Framework has not been widely applied to investigate adherence by people with psoriasis. This thesis reports research into psychological factors associated with medication adherence in psoriasis. Methods: A systematic review of adherence to treatments (Phase 1) was followed by a qualitative investigation of measures of adherence and treatment beliefs (Phase 2). A large-scale multisite quantitative survey of levels and determinants of adherence to systemic psoriasis treatments was carried out by linking new psychological measures with data from a national treatment registry (Phase 3). Finally a mixed-methods investigation into self- regulatory approaches to the understanding of adherence was undertaken (Phase 4). Findings: i) Adherence difficulties are prevalent in psoriasis, however poor methodology quality of previous studies limited conclusions of the systematic review ii) Patients using topical preparations described significant day-to-day variations in medication use as well as complex treatment decision-making processes; however, key behaviours and cognitions were not accurately reflected by corresponding scores of the standardised scales iii) Patients using systemic treatments reported high levels of adherence which were associated with: biologic rather than a traditional systemic; fewer concerns about systemic treatments; and lower PASI and DLQI scores. Unhealthy lifestyle behaviours were also prevalent iv) Effective treatment usage in psoriasis conflicted with the management of the physical and psychological demands of living with psoriasis. For patients using topical preparations, non-adherence was a strategic decision to reduce distress and gain control. Patients using systemic treatments expressed strong beliefs in the necessity of their treatment, yet reported high levels of anxiety and depression. Systemic treatment usage conflicted with the management of illness controllability and psychological adjustment. A more negative illness belief profile and greater appearance concerns accounted for the most variance in both anxiety and depression, even after controlling for disease severity. These findings have major implications for the measurement of adherence and treatment beliefs, as well as researchers’ ability to determine clinical outcomes and treatment response. Conclusions: Psoriasis treatment adherence can be practically challenging as well as emotionally charged. The construct of self-regulatory failure proved to be illuminating and improves understanding of the psychological processes that underpin medicines adherence and other aspects of self- management in people with psoriasis.
Supervisor: Cordingley, Mary Sponsor: Psoriasis Association of Great Britain and Ireland ; Medical Research Council
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Psoriasis ; Medication ; Adherence ; Common Sense Self-Regulatory Model ; Necessity-Concerns Framework