Personalised adherence support for maintenance treatment of inflammatory bowel disease: a tailored digital intervention to change adherence-related beliefs and barriers

Background and aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm tailoring support to address perceptual and practical barriers to adherence reduced barriers and was acceptable to patients with IBD. Methods: Participants with IBD, prescribed azathioprine and/or mesalazine were recruited via patient groups, social media and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline, one and three months of follow-up. Results: 329 participants were allocated to the Intervention (n=153) and Control (n=176) Groups; just under half (46.2%) completed follow-up. At one and three months the Intervention Group had significantly fewer concerns about IBD medication (p≤.01); and, at three months only, fewer doubts about treatment need, fewer reported practical barriers and lower nonadherence (p<.05). Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews and intervention usage indicated the intervention was acceptable. Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual (doubts about treatment necessity and medication concerns) and practical barriers to adherence.