“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 Q

Kathryn King,1 Christine Norton,1 Awa Jammeh,1 Trudie Chalder,2 Wladyslawa Czuber-Dochan1 1Florence Nightingale Faculty Nursing Midwifery and Palliative Care, King’s College London, London, UK; 2Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKCorrespondence: Kathryn King, Florence Nightingale Faculty Nursing Midwifery and Palliative Care, King’s College London, London, SE1 8WA, UK, Email [email protected]: 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.Plain Language Summary: Many people with inflammatory bowel disease (IBD) do not take their medication as prescribed. This is called non-adherence. Understanding the reasons for this may help to improve the support patients receive, which could lead to better disease control, less wasted medication, and reduced healthcare costs.Twenty-one healthcare professionals (HCPs) from different professional backgrounds currently working in gastroenterology services were interviewed.The findings highlight four main themes; 1) HCPs’ views on patients’ adherence and related behaviors; 2) how HCPs perceive themselves supporting people with IBD in taking medication; 3) barriers that make providing adherence support difficult; and 4) ideas for improving support in the future.HCPs discussed many reasons why people take or avoid their medication. Some can be addressed through compassionate care that focusses on patient’s needs and wellbeing. Educating patients about IBD and treatments in clear, simple language was seen as essential for understanding and adherence. Patients also need to feel respected and involved in decisions about their care.HCPs themselves can be better supported through teamwork, shared responsibility of adherence with both the team and patients, and access to training that is practical and feasible within busy services. Healthcare systems should allow enough time and capacity for HCPs to provide meaningful adherence support. In addition, technological tools, used alongside effective healthcare, may help people with IBD take their medication as recommended.Keywords: inflammatory bowel disease, medication adherence, medication concordance, qualitative study, interviews, healthcare professionals’ perspectives