P1158Ethnic differences in medication adherence and illness perception in Inflammatory Bowel Disease: A comparative study of White and South Asian patients

Background Research into ethnic variation in medication adherence and illness perception in IBD is limited, despite the high incidence of IBD among South Asians (SA) in the UK1, and known disparities in other chronic diseases. Using validated questionnaires, medication adherence, medication perception and disease perception were evaluated in White (WH) and SA IBD patients. Methods Patients were recruited from outpatient clinics across four London IBD centres. Data were collected on self-reported adherence [Medication Adherence Report Scale (MARS)2], beliefs about medicines [Beliefs about Medicines Questionnaire (BMQ)3] and illness perceptions [Brief Illness Perception Questionnaire (Brief-IPQ)4]. Mann–Whitney U tests were used to compare questionnaire scores between cohorts. Spearman correlation was used to examine the association between MARS and BMQ scores. Multivariate logistic regression was performed to identify independent predictors of adherence. Results 300 patients were recruited [66% WH, 34% SA; 44% female; median age 41 years (IQR 29–57)]. 62% of WH and 58% of SA patients were prescribed advanced therapies. When compared to WH patients, SA patients self-reported lower medication adherence [MARS score: WH 4.1 (IQR 3.7–4.3) vs. SA 3.8 (IQR 3.5–4.1), p < 0.001]. The BMQ-Specific Concern score was higher in SA compared to WH [WH 2.8 (IQR 2.2-3.4), SA 3.2 (IQR 2.7-3.8), p < 0.001] indicating a greater level of concern about the potential negative consequences of medications. There was a negative correlation between BMQ-Specific Concern scores and medication adherence among SAs [r = –0.37, p < 0.001]. Compared to WH patients, SA patients experience a greater perceived seriousness of the illness [p = 0.008], reduced perceived effectiveness of treatment [p = 0.008], greater general concerns about IBD [p = 0.002] and a greater emotional impact of the illness [p = 0.02]. Diet was the leading perceived cause of IBD among SAs, while psychological and stress-related factors ranked highest among WH participants. In a multivariable analysis, SA ethnicity [adjusted OR 0.35, 95% CI 0.11–0.87; p = 0.04] and greater concerns about medication consequences [BMQ-Specific Concern score; adjusted OR 0.60, 95% CI 0.38–0.95; p = 0.032] were independently associated with reduced adherence. Conclusion Self-reported adherence to IBD therapy was lower in SA compared to WH patients and associated with more negative perceptions of illness and medications. Approaches to improve medication adherence in the SA patient group should focus on concerns around medication adverse events. These findings underscore the need for culturally tailored, individualized approaches in IBD care to improve adherence and, ultimately, patient outcomes. References: 1. Misra R, Limdi J, Cooney R, et al. Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception epidemiology study. World J Gastroenterol. 2019;25(40):6145-6157. doi:10.3748/wjg.v25.i40.6145 2. Chan AHY, Horne R, Hankins M, Chisari C. The Medication Adherence Report Scale: A measurement tool for eliciting patients’ reports of nonadherence. Br J Clin Pharmacol. 2020;86(7):1281-1288. doi:10.1111/bcp.14193 3. Horne R, Parham R, Driscoll R, Robinson A. Patientsʼ attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease: Inflamm Bowel Dis. 2009;15(6):837-844. doi:10.1002/ibd.20846 4. Broadbent E, Petrie KJ, Main J, Weinman J. The Brief Illness Perception Questionnaire. J Psychosom Res. 2006;60(6):631-637. doi:10.1016/j.jpsychores.2005.10.020 Conflict of interest: Balarajah, Sharmili: SB has received financial support to attend educational meetings from Falk and Ferring Sundramoorthi, Rohan: No conflict of interest Hussain, Yusuf: No conflict of interest Nicholas, Victoria: No conflict of interest Prabhudev, Hemanth: No conflict of interest Perry, Robert: RWP has received financial support to attend conferences from Ferring Foulser, Peter: No conflict of interest Alexander, James: James has received speaker fees from Pfizer, Abbvie, Takeda and Janssen. He has received travel grants and support to attend meetings from Lilly, Tillotts Pharma, Takeda and Celltrion. Mullish, Benjamin: No conflict of interest Mehta, Shameer: Personal fees: Pfizer, Takeda, Johnson&Johnson Parkes, Gareth: No conflict of interest Mohamed, Zameer: No conflict of interest Johnston, Emma: No conflict of interest Hart, Ailsa: Grant: Takeda Personal Fees: Abbvie, Amgen, Arena, AZ, Falk, Celltrion, Eli Lilly, Ferring, Genentech/ Roche, GSK, Pfizer, Takeda, Napp, Pharmacosmos, Janssen (J&J), Bristol-Myers Squibb, Gilead, Galapagos, Alfasigma Orchard, Timothy: No conflict of interest Hicks, Lucy: No conflict of interest Williams, Horace: Fees from Pfizer, Takeda, Tillotts Pharma.