Factors influencing the beliefs of patients with rheumatoid arthritis regarding disease modifying medication: reply

L. J. Goodacre and J. A. Goodacre

Lancashire Postgraduate School of Medicine and Health, University of Central Lancashire, Preston, UK

Correspondence to: L. J. Goodacre. E-mail: lgoodacre{at}uclan.ac.uk

We thank W. Holden, J. Joseph and L. Williamson for their interest in our paper. The study described in this letter investigated the level of knowledge which patients with RA have about disease-modifying anti-rheumatic drugs (DMARDs), using a questionnaire. The findings suggest that, of those taking a DMARD who completed the questionnaire, many had limited knowledge about their treatment. It would have been interesting to have explored further the reasons for this in this group. In our study we set out to investigate patients’ beliefs about DMARDs, rather than to test their knowledge of these medications, and chose for this purpose to use a qualitative approach. In adopting a purposive approach to sampling, we selected the experience we wished to gain insight into rather than the individual participants.

We made no attempt to assess levels of knowledge or draw conclusions relating to levels of knowledge or ignorance. In our study, and in a further study being conducted currently, we also found that patients have problems with naming their medication correctly and in explaining the rationale for the use of the medication or for monitoring. However, the majority remembered being given the information, all attended monitoring and many had kept leaflets and educational material for reference purposes.

Knowledge is likely to be one of a number of factors which determine beliefs and behaviour relating to medication. Further work is needed to understand what is classed as important information from the perspectives of patients as well as clinicians, and how knowledge and beliefs interact to inform decisions and behaviour. Whilst supporting the role of education in relation to medication, we would suggest that for educational interventions to be effective they need to be tailored to the needs of patients, which are likely to change over the course of their disease. The constant reinforcement of standard educational messages is unlikely to impact on expectations, behaviour and outcomes.

The authors have declared no conflicts of interest.

Accepted 4 August 2004





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