Table 2 Patient reports of modifications to treatment regimens and understanding of illness and treatment
Reported modifications to treatment regimen | Understanding of treatment regimen (how drugs work and/or how to take them) and correlation with medical records | Understanding of illness (es) (incl. disease progression, symptomatology) | Adherence classification | |
|---|---|---|---|---|
P1 | Self-medicates despite being told not to do so by the doctor; takes an OTC analgesic | Poor understanding of how drugs work | Limited understanding of illness. Cartilage is being eaten away, causing joint pain. RA is caused by many years of performing household chores that involve use of water | Intentional non-adherer |
P2 | Does not use traditional medicines or CAM; self-medicates with previously prescribed pain medicines; increases insulin when sugar levels are too high | Poor understanding of regimen; discrepancies in records versus patient description of drugs | Cannot link her symptoms to her various chronic conditions Hard work/chores cause RA | Intentional non-adherer |
P3 | Scared of mixing medicines | Does not know what drugs are for, just takes them | Limited understanding of illness RA is caused by over-exposure to cold temperatures | Adherer |
P4 | Took ‘bone medicine’ acquired illegally from hospital; deliberately skips evening doses when not in pain | Basic understanding of what drugs are for, does not understand how they work | Limited understanding of illness Fluid in the joints has run out, causing pain when cartilage gets worn out. No known cause of RA, you just get it | Intentional non-adherer |
P5 | Self-medicates with topical mustard and garlic oil; drinks lemon water with honey | Did not include all drugs in description of regimen; does not understand how drugs work | Limited understanding of illness Red blood cells are fighting the white blood cells. RA might be genetic | Non-intentional non-adherer |
P6 | Sometimes feels like taking a break from medicines; scared to mix medicines | Takes so many pills, she forgets the names; clear understanding of how to take drugs, which does not match records; good understanding of RA and DM drugs | Understands RA and DM best, although vaguely; poor understanding of HT and Ch Bones are being eaten away. RA caused by over-working yourself. | Intentional non-adherer |
P7 | Drinks ‘Forever Living’ (a tonic containing aloe vera extract) | Poor understanding of HT drugs; knowledgeable about RA drugs | Not concerned about HT; poor knowledge of HT, good knowledge of RA Immune system is attacking the joints and causing inflammation; cartilage gets eaten away. RA might be hereditary but doctors are uncertain. | Intentional non-adherer |
P8 | Does not take chloroquine because it ruins her eyes; drinks ‘Lavida tea’ (an organic herbal tea) | Unable to recall all drugs; not taking everything correctly; uncertain about how drugs work | Limited understanding of illness Nature of disease not explained. RA just happens; not related to hard work or chores. | Intentional non-adherer |
P9 | Does not self-medicate since proper diagnosis was made | Not taking drugs as prescribed; taking drugs that were previously prescribed; does not know names of drugs; does not know what drugs are for | Does not understand illness The gel between the bones is finished causing pain when they rub together. Cause is unknown, not chores related. | Intentional non-adherer |
P10 | Does not self-medicate | Could not recall all drugs but seems to be taking them correctly; taking triple dosage in error for one drug; does not understand what drugs are for | Limited understanding of illness Exposure to water and cold causes RA | Non-intentional non-adherer |
P11 | Does not self-medicate or mix medicines due to possible side effects | Good understanding of drugs | Good understanding of illness Immune system incorrectly identified something in the body as foreign and has mounted an attack. Cartilage between bones has been eaten away, causing pain. Cause unknown | Adherer |
P12 | Does not self-medicate because she’s afraid of side effects | Describes drug regimen correctly, but does not know which drug is for which condition | Less concerned about HT than RA Cartilage has been eaten way causing pain. No cause | Adherer |
P13 | Initially self-medicated with NSAIDS; uses aloe (traditional medicine); stops taking medicines sometimes, just to see how her body will feel | Could not recall all drugs but seems to know how to take them correctly | Limited understanding of illness Bones and joints swell and cause pain. Cause is still unknown | Non-intentional non-adherer |
P14 | Understands importance of calcium but does not take it due to taste and side effects; self-medicates with joint support pills and pain killers obtained illegally from pharmacy | Understands drugs for each condition; mostly clear on how to take drugs and how they work | Limited understanding of illness RA caused by hard work and exposure to cold. Hereditary | Intentional non-adherer |
P15 | Overdoses on medicines to help her sleep; sometimes skips HT medicine; self-medicates with ‘phila’ (traditional remedy) for DM | Could not remember all drugs; some understanding of what they are for; lack of understanding leads to overdosing | Does not fully understand all her conditions Bones being eaten away by excess acid. RA caused by the cold | Non-intentional non-adherer |
P16 | If she misses a weekly dose, she waits until the next week as she was told not to switch days | Some misconceptions about why she takes certain drugs; recognises drug names and knows how to take them | Limited understanding of illness Bones are rubbing up against each other which causes pain because cartilage is worn out. No real cause; could be a curse | Adherer |
P17 | Does not self-medicate | Seems clear on how to take drugs and what they are for | Limited understanding of illness Fluid between the bones in finished, causing friction between the bones. No cause | Adherer |
P18 | Was taking OTC medications until they could no longer control pain | Understands how to take drugs and has some understanding of what they are for | Limited understanding of illness The joints are being attacked which depletes the gel between them. Causes friction and pain. Might be a result of smoking but the cause is not known | Adherer |