“You Can Lead a Horse to Water, but You Can’t Make It Drink”. Gastroenterology Healthcare Professionals’ Perceptions of Reasons for Patient Non-Adherence to Inflammatory Bowel Disease Prescribed Medication: A Qualitative Study

Purpose: Inflammatory bowel disease (IBD) is commonly treated with medications to induce and maintain remission. Yet many patients do not take treatments as prescribed. Understanding healthcare professionals' (HCPs) beliefs about medication non-adherence may help clarify whether their views align with patients' experiences and inform future adherence support strategies. Patients and Methods: Semi-structured interviews were conducted with 21 purposively selected HCPs from diverse professional backgrounds working within gastroenterology in the National Health Service (publicly funded healthcare system in the United Kingdom). Interviews were video recorded, transcribed verbatim, and analyzed using Braun and Clarke's principles of reflective thematic data analysis. Results: Four main themes were identified: 1) HCPs' perceptions of patients' adherence, including perceived reasons for adherence and non-adherence, honesty about adherence, sub-group differences, and the language used in consultations. 2) how HCPs seek to promote adherence through empathy, reassurance, provision of information, practical tools, support strategies, and treatment decisions aligned with patients' needs. 3) challenges for supporting adherence, including everyday practice barriers, systemic constraints, and reflections on whether HCPs themselves may contribute to the problem. 4) what is needed to improve adherence, encompassing support for patients, HCPs, and healthcare systems, as well as proposed intervention approaches. Conclusion: HCPs recognize that adherence in IBD is shaped by multiple determinants, many of which can be influenced through clinical practice and patient interactions. Strategies such as empathy, reassurance, clear communication, reliable information, medication-taking tips, are believed to support adherence whilst providing safe practice. However, challenges arise from patient-, professional-, and system-level factors. Addressing these requires shared responsibility between clinician and patient, adequate consultation time, improved service capacity and sustained person-centered care. Flexible and timely training for HCPs may also enhance adherence support. Capturing HCPs' perspectives offers valuable insight into medication adherence in IBD and can inform strategies to strengthen adherence support within clinical care.