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Title:	Subcutaneous biologic therapy in inflammatory arthritis patients: development of adherence assessment tool based on the theoretical domain framework
Authors:	Salmi Abdul Razak (P87777)
Supervisor:	Adyani Md Redzuan, Assoc. Prof. Dr.
Keywords:	Arthritis Antirheumatic Agents Universiti Kebangsaan Malaysia -- Dissertations Dissertations, Academic -- Malaysia
Issue Date:	20-Aug-2022
Description:	The introduction of the biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) therapy to manage Inflammatory Arthritis (IA) diseases following the treat-to-target strategies result in better functionality and quality of life among IA patients. However, studies reported that 20-40% of IA patients were non-adherent to their self-injectable bDMARDs. The impact of non-adherence to the prescribed bDMARDs may result in premature discontinuation of effective therapy, incidence of immunogenicity, and poor IA disease outcome. Indirect adherence assessment methods on oral medications have been extensively discussed, but few were done on the self-injectable bDMARDs. Therefore, this study consists of three phases to develop and validate a new adherence tool to assess adherence status among IA patients on subcutaneous (sc) bDMARDs, based on the Theoretical Domain Framework (TDF) linked to the Capability, Opportunity, Motivation and Behaviour (COM-B) model. Firstly, bDMARDs usage patterns and reasons for discontinuation were done retrospectively on 110 adult IA patients at five hospitals in the central region of Peninsular Malaysia. Secondly, a newly developed and validated questionnaire quantifying 63 IA patients' opinion perception scores was constructed from the TDF-linked to the COM-B model to identify appropriate intervention functions and policy categories to be implemented to improve the sc bDMARDs adherence behaviour. This study identified a correlation between opinion perception scores for COM among IA adherence behaviour on sc bDMARDs. Third, a new adherence tool to assess adherence status among IA patients on sc bDMARDs was further developed based on the second phase study and validated for content validity and reliability on 50 IA patients on sc bDMARDs. The first phase study found that non-adherence issues were the highest reasons for bDMARDs treatment interruption and discontinuation among the study population (26, 23.6%). The Adherence Behaviour to sc bDMARDs (ABSBio) questionnaire with 33 items was developed and validated with a Chronbach's Alpha value of 0.835. Social influences, drug information resources in the opportunity domain, and components in the capability domain, memory and attention, require changes to improve adherence to sc bDMARDs among IA patients. Appropriate intervention functions and policy categories to be implemented were enablement and service provision, respectively. IA patients' adherence behaviour on sc bDMARDs was found to have a strong positive correlation between capability and motivation scores. The sc bDMARDs Adherence Score (SCADS) questionnaire with ten items was developed from findings from the second phase of this study was found to be consistent and reliable with a Chronbach's Alpha value of 0.707. The SCADS questionnaire is proposed to be used during daily routine clinical practice to assess adherence status among IA patients currently prescribed with sc bDMARDs. To date, this is the first research in Malaysia using a quantitative approach using the TDF linked to the COM-B model to analyze a targeted medication adherence behaviour on a specific target population, the IA patients currently on sc bDMARDs,Ijazah Doktor Falsafah
Pages:	244
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Pharmacy / Fakulti Farmasi

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