N04 Linking adherence and self-care in IBD

Abstract Background Medication nonadherence and suboptimal self-care are common in inflammatory bowel disease (IBD), and are associated with increased relapse rates, unplanned health care use, and reduced quality of life. However, the psychological mechanisms underpinning these behaviors are still poorly understood. This study examined whether self-efficacy mediates the relationship between medication adherence and self-care behaviors in adults with IBD. Methods We conducted a multicenter cross-sectional secondary analysis of 453 clinically stable outpatients with Crohn’s disease or ulcerative colitis, consecutively enrolled from nine Italian hospitals. Sociodemographic and clinical data were collected through medical records and patient interview. Medication adherence, self-efficacy, and self-care (maintenance, monitoring, management) were assessed using the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analysis (PROCESS model 4 with 5000 bootstrap samples) were used to explore associations and the mediating effect of self-efficacy, adjusting for relevant covariates. Results Only 10.1% of patients reported high medication adherence, while 89.9% had low or medium adherence. Self-efficacy levels were moderate overall and significantly higher in patients with high adherence. Medication adherence correlated positively with self-care maintenance (r = 0.12, p = 0.011) and self-efficacy (r = 0.11, p = 0.015), but not with self-care monitoring or management. Self-efficacy was associated with self-care maintenance and significantly mediated the relationship between medication adherence and self-care maintenance (indirect effect = 0.25, 95% CI 0.05–0.50), explaining 9.3% of the variance in maintenance behaviors, while no significant mediation emerged for monitoring or management. Conclusion In adults with IBD, medication adherence is closely linked to self-care maintenance, and this relationship is partially explained by patients’ self-efficacy. These findings support the systematic assessment of adherence and self-efficacy in routine care, and the development of tailored educational and digital interventions explicitly aimed at strengthening patients’ confidence in managing their condition. Targeting self-efficacy may represent a feasible strategy to simultaneously improve medication adherence and self-care, with potential benefits on long-term clinical and patient-reported outcomes. References: Gohil S, Majd Z, Sheneman JC, Abughosh SM. Interventions to improve medication adherence in inflammatory bowel disease: a systematic review. Patient Educ Couns. 2022;105(7):1731-1742. Sheehan JL, Greene-Higgs L, Swanson L, et al. Self-efficacy and the impact of inflammatory bowel disease on patients’ daily lives. Clin Transl Gastroenterol. 2023;14(6):e00577. Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci.2012;35(3):194-204. Napolitano D, Vellone E, Iovino P, Scaldaferri F, Cocchieri A. Self-care in patients affected by inflammatory bowel disease and caregiver contribution to self-care (IBD-SELF): a protocol for a longitudinal observational study. BMJ Open Gastroenterol. 2024;11(1):e001510. Conflict of interest: Martella, Piergiorgio: No conflict of interest Napolitano, Daniele: No conflict of interest Cesare, Manuele: No conflict of interest Cocchieri, Antonello: No conflict of interest