Racial differences in medication beliefs and adherence barriers among patients with systemic lupus erythematosus.
Date
2026-01
Journal Title
Journal ISSN
Volume Title
Citation Stats
Attention Stats
Abstract
IntroductionBlack patients with systemic lupus erythematosus (SLE) have lower medication adherence than White patients, contributing to worse health outcomes. However, racial differences in reasons for nonadherence and beliefs about medications are not well understood.MethodsWe conducted a cross-sectional analysis of Black and White patients with SLE who completed the Beliefs about Medicines Questionnaire and the SLE-specific Domains of Subjective Extent of Nonadherence survey. We compared scores by race and by adherence level within each racial group.ResultsAmong 123 patients (52% Black, 48% White), adherence was lower in Black patients (44% vs 64%, p = .02). Black patients reported greater concerns about SLE medications and medication overuse and harm than White patients. Nonadherent Black patients reported weaker beliefs in SLE medication necessity and greater concerns about medication overuse and harm than adherent Black patients. Reasons for nonadherence reported by Black patients but not White patients included feeling well (45%), concerns about future fertility (14%), and doubts about their doctors and medicines (8%).ConclusionNonadherence among Black patients was uniquely associated with stronger concerns about medication overuse and harm and weaker beliefs that SLE medicines were necessary, potentially reflecting medical mistrust that may drive skipping doses when feeling well or when concerns arise. These insights can help clinicians more astutely probe and address each patient's needs to enhance medication adherence and SLE management.
Type
Department
Description
Provenance
Subjects
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Rangaswamy, Shivani, Amanda M Eudy, Megan EB Clowse, Jennifer Rogers, Rebecca E Sadun, Lisa G Criscione-Schreiber, Jayanth Doss, Mithu Maheswaranathan, et al. (2026). Racial differences in medication beliefs and adherence barriers among patients with systemic lupus erythematosus. Lupus, 35(1). pp. 93–98. 10.1177/09612033251406326 Retrieved from https://hdl.handle.net/10161/33868.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Amanda Marie Eudy
Megan Elizabeth Bowles Clowse
Dr. Megan Clowse is a Professor of Medicine and Chief of the Division of Rheumatology and Immunology; she also holds joint appointments in the Department of Obstetrics and Gynecology and Population Health Sciences. Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 1000 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository. She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020. Dr. Clowse created www.LupusPregnancy.org and www.ReproRheum.Duke.edu, websites dedicated to improving pregnancy planning and management for patients and rheumatologists.
Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers. The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to better clarify this construct.
Jennifer Lee Rogers
Rebecca Eli Sadun
I am an adult and pediatric rheumatologist with clinical and research interests in the areas of lupus and transition to adult care. My time is split between the departments of Medicine and Pediatrics. In addition to seeing patients in both environments, I run a dedicated Young Adult Rheumatology Clinic in collaboration with Duke Family Medicine.
Lisa Giorgina Criscione-Schreiber
My clinical interests include systemic lupus erythematosus (SLE) and inflammatory myopathies. In 2007, I co-founded the Duke Lupus Clinic with Dr. Megan Clowse. We have continued this clinic with the aim to improve the health and quality of life for individuals living with lupus. In 2024, I co-founded the Duke Myositis Clinic with Dr. Nathaniel Harris. Similarly, we aim to improve the health, function, and quality of life for individuals living with inflammatory myopathies.
My primary research interests are in education and in SLE. My particular interest within education is learner assessment. I was previously funded by a Clinician Scholar Educator Award through the Rheumatology Research Foundation of the American College of Rheumatology. My CSE project explored validation of a rheumatology objective structured clinical examination (ROSCE). I continue to collaborate with the Rheumatology Program Directors at UNC Chapel Hill, Wake Forest University, the Medical University of South Carolina and Massachusetts General Hospital through our Carolinas Fellows Collaborative. Members of this group composed the competency-based goals and objectives (CBGO) for all learning activities of rheumatology fellowship training programs, which were adopted by the American College of Rheumatology and are posted on their website. I have been very involved in rheumatology curricular efforts through the American College of Rheumatology. I served on the Milestones working group and am a past member and past Chair of the ACR Curriculum Subcommittee of the Committee on Training and Workforce. I previously participated on the ACR/NBME rheumatology in-training examination working group.
Clinical research in lupus has included the Duke Lupus Registry population. Our recent work focuses on creating and defining the type 1 and type 2 lupus paradigms for classifying lupus disease activity. Additional interests through the Duke Lupus Clinic include elucidating clinician-level factors that can influence medication adherence as well as determining how health literacy and numeracy impact adherence and patient level outcomes. I collaborate with Dr. Megan Clowse, who studies reproductive health in women with autoimmune diseases. We have combined her subject matter expertise with my educational skills to create HOP-STEP, a program to teach patients with lupus and their rheumatologists about pregnancy planning to improve health outcomes. We have created lupuspregnancy.org, which houses many resources and videos designed to teach rheumatologists to better partner with women with lupus to have open and honest discussions about pregnancy planning. Our ultimate aim is to improve the health outcomes for women with lupus and their offspring.
Mithunan Maheswaranathan
Nathaniel Joseph Harris
Kai Sun
My clinical interests are in general rheumatology, lupus, and musculoskeletal ultrasound. My research interest is in healthcare disparities and medication adherence in rheumatology.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.