Table 3 New insights on factors associated with non-adherence

1

Patient’s strong opinion, similar to a dogma

“Patient’s dogma”, meaning that strong opinions, values, or beliefs that people accept without any doubts facilitated non-adherence.

I am 77 years old now, always worked hard and long hours. I raised 6 children and I was never unemployed. It is no wonder that I am in pain. It indicates that I have been working hard all my life (participant no. 150, female, age 76, Vienna).

I don’t like drugs. Drugs made me sick. I never really recovered from that sickness drugs made me. I stopped taking medication. I have now bought a magnetic field mat, changed my diet and now I have no pain anymore (participant no. 48, female, age 56, Graz).

Motivation

2

Feeling not to be in expert’s hands when being treated by a physician/health professional

Patients searched for the best and most trustworthy physician/health professional. They had less trust in physicians/health professionals when: physicians appeared to be young regarding their age; when physicians disagreed with the opinions of other physicians; or when a physician consulted another physician for advice.

At the outpatient clinic, two doctors said different things—then I was confused what I should do. Then, I decided not to come to the next appointment anymore (participant no. 28, female, age 43, Graz).

The young, unexperienced doctors always want to prescribe drugs [DMARDs], but if that does not work then they are immediately at a loss, do not know what to do and then I simply do not feel well (participant no. 165, male, age 70, Vienna).

Motivation

3

Excessive self-control

Patients who perceived excessive self-control over the treatment were less adherent.

When the symptoms are more severe I go to see the doctor, but if they are only mild then I treat them by myself, because I know what will help anyway (participant no. 182, female, age 34, Vienna).

It has been a long time since I was at the outpatient clinic. The drug made me uncomfortable. I vomited a lot. I never stopped taking it, because I need it. But I reduced it by myself to half the amount that the doctor had prescribed. The reduction did not affect the pain and I stopped feeling uncomfortable (participant no. 170, female, age 45, Vienna).

Opportunity, with a negative connotation (not using the opportunity)

4

Missing a holistic approach

Some patients did not feel properly taken care of if physicians only prescribed medicines without addressing non-pharmacological aspects of treatment, including life-style advice, physical activity and diet, as well as alternative therapies.

All I got at the outpatients clinic was medication. Nothing else. I did water gymnastics with my daughter—that was very beneficial for me, as well as mud treatments (participant no. 99, female, age 56, Vienna).

There are also recommendations, for example regarding diet. That is never mentioned. Also regarding sports. The patients have to find out these things for themselves. They are only instructed us regarding medication here (participant no. 182, female, age 34, Vienna).

Motivation