Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff.

dc.contributor.author

Sun, Kai

dc.contributor.author

Corneli, Amy L

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Dombeck, Carrie

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Swezey, Teresa

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Rogers, Jennifer L

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Criscione-Schreiber, Lisa G

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Sadun, Rebecca E

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Eudy, Amanda M

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Doss, Jayanth

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Bosworth, Hayden B

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Clowse, Megan EB

dc.date.accessioned

2023-11-12T17:43:23Z

dc.date.available

2023-11-12T17:43:23Z

dc.date.issued

2022-09

dc.date.updated

2023-11-12T17:43:22Z

dc.description.abstract

Objective

Underrepresented racial and ethnic minorities are disproportionately affected by systemic lupus erythematosus (SLE). Racial and ethnic minorities also have more severe SLE manifestations that require use of immunosuppressive medications, and often have lower rates of medication adherence. We aimed to explore barriers of adherence to SLE immunosuppressive medications among minority SLE patients.

Methods

We conducted a qualitative descriptive study using in-depth interviews with a purposive sample of racial minority SLE patients taking oral immunosuppressants (methotrexate, azathioprine, or mycophenolate), and lupus clinic providers and staff. Interviews were audiorecorded, transcribed, and analyzed using applied thematic analysis. We grouped themes using the Capability, Opportunity, Motivation, Behavior conceptual model.

Results

We interviewed 12 SLE patients (4 adherent, 8 nonadherent) and 12 providers and staff. We identified capability barriers to include external factors related to acquiring medications, specifically cost-, pharmacy-, and clinic-related issues; opportunity barriers to include external barriers to taking medications, specifically logistic- and medication-related issues; and motivation factors to include intrinsic barriers, encompassing patients' knowledge, beliefs, attitudes, and physical and mental health. The most frequently described barriers were cost, side effects, busyness/forgetting, and lack of understanding, although barriers differed by patient and adherence level, with logistic and intrinsic barriers described predominantly by nonadherent patients and side effects described predominantly by adherent patients.

Conclusion

Our findings suggest that interventions may be most impactful if they are designed to facilitate logistics of taking medications and increase patients' motivation while allowing for personalization to address the individual differences in adherence barriers.
dc.identifier.issn

2151-464X

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2151-4658

dc.identifier.uri

https://hdl.handle.net/10161/29376

dc.language

eng

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Wiley

dc.relation.ispartof

Arthritis care & research

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10.1002/acr.24591

dc.subject

Humans

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Lupus Erythematosus, Systemic

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Azathioprine

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Immunosuppressive Agents

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Qualitative Research

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Ethnic and Racial Minorities

dc.title

Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff.

dc.type

Journal article

duke.contributor.orcid

Sun, Kai|0000-0002-8406-2932

duke.contributor.orcid

Corneli, Amy L|0000-0002-4629-4329

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Sadun, Rebecca E|0000-0001-7768-3565

duke.contributor.orcid

Eudy, Amanda M|0000-0002-3107-5545

duke.contributor.orcid

Bosworth, Hayden B|0000-0001-6188-9825

duke.contributor.orcid

Clowse, Megan EB|0000-0002-8579-3470

pubs.begin-page

1459

pubs.end-page

1467

pubs.issue

9

pubs.organisational-group

Duke

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School of Medicine

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Pediatrics

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Psychiatry & Behavioral Sciences

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Medicine, General Internal Medicine

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Medicine, Rheumatology and Immunology

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Pediatrics, Rheumatology

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Duke Cancer Institute

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Duke Clinical Research Institute

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Duke Global Health Institute

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Center for the Study of Aging and Human Development

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Initiatives

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Duke Science & Society

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Population Health Sciences

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Duke Innovation & Entrepreneurship

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Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

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Duke - Margolis Center For Health Policy

pubs.publication-status

Published

pubs.volume

74

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