Implication Of Character Traits In Adherence To Treatment In People With Gout: A Reason For Considering Nonadherence As A Syndrome
Received 15 August 2019
Accepted for publication 11 October 2019
Published 7 November 2019 Volume 2019:13 Pages 1913—1926
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Gérard Reach,1,2 Gaëlle Chenuc,3 Pascal Maigret,4 Isabelle Elias-Billon,4 Luc Martinez,5 René-Marc Flipo6
1Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, APHP, Bobigny, France; 2Health Education and Practices Laboratory (LEPS, EA 3412), Paris 13 University, Sorbonne Paris Cité, Bobigny, France; 3Capionis Research, Bordeaux, France; 4Medical Department, Menarini, Rungis, France; 5Family Practice, La Rochelle, France; 6Department of Rheumatology, University Hospital, Lille, France
Correspondence: Gérard Reach
Direction Qualité, Hôpital Avicenne, APHP, 125 Route de Stalingrad, Bobigny 93000, France
Tel +33 6 60 84 53 25
Objective: Various aspects of nonadherence to therapy (including medication and lifestyle nonadherence) often appear together. Here we report the association between treatment adherence in gout and the two character traits of patience and obedience, which may explain this observation.
Methods: Data were collected from a cross-sectional study conducted in a French cohort of 1441 adult patients. Patience was assessed using the choice between receiving €1500 in 1 year or €500 immediately. Obedience was evaluated with a single question assessing the use of the seatbelt in the rear seat of a car. Adherence to recommendations for medication, beverage, food and physical activity and smoking status was assessed using self-report questionnaires.
Results: Patience and obedience were strong determinants of adherence to medication in multivariate analysis (OR 2.056, 95% CI [1.414–2.989], P< 0.001; OR 1.844, 95% CI [1.273–2.671], P=0.001). In univariate analysis, adherence to medication was also associated with compliance with dietary directives (P<0.001), lower alcohol consumption on an ordinary day (P< 0.001), never consuming soda (P<0.001) or beer (P<0.001), practice of physical activity (P=0.002), being a nonsmoker (P<0.001) and monitoring serum levels of uric acid regularly (P=0.011). Multiple-correspondence analysis illustrated the associations of these different aspects of adherence (medication, diet and exercise, smoking status and monitoring of disease control) with patience and obedience. Finally, we observed a link between patience and obedience (P< 0.001).
Conclusion: Character traits, which shape preferences, may cause the clustering of different aspects of nonadherence in the form of a syndrome, elucidating the still enigmatic link between nonadherence to placebo and mortality in randomised clinical trials. This concept may also explain, at least in part, the difficulty of improving adherence to long-term therapies and may lead to ethical issues.
Keywords: adherence, patience, obedience, nonadherence syndrome, character traits, gout
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