Sociodemographic Factors Linked to Topical Psoriasis Treatment Non-Adherence

A new study found higher education, single-family household, active employment status, family history of psoriasis, and the presence of obsessive-compulsive symptoms were linked to greater odds of adhering to topical treatment for psoriasis.¹

“These results underscore the importance of multidisciplinary treatment approaches that consider patients’ psychosocial profiles alongside clinical parameters,” wrote investigators, led by Ana Teixeira, from the Institute for Health and Bioeconomy, University Institute of Health Sciences, at Gandra, Portugal.

Previous research found patients with psoriasis adhered less to treatment due to perceptions of psoriasis. Experiences with adverse effects, poor communication with the health care professionals, cost, and not liking previous treatment regimens may have invoked fear. The same study found adherence was linked to psychosocial factors, such as the relationship between the healthcare professional and patient, perceptions of treatment concerns, necessity beliefs, and practical barriers to treatment.²

Investigators sought to examine the effect of psychosocial and clinical factors on adherence to topical treatment in psoriasis.1 The team analyzed 102 patients with psoriasis recruited from Portuguese private and public health institutions, familial health unities, hospitals, and a psoriatic patients’ association (PSOPortugal). Participants had to be > 18 years old, treated exclusively with topical medicines such as gels, creams, or ointments, and had a physician’s prescription for the psoriasis treatment.

Investigators evaluated adherence through the self-reported Questionnaire for Adherence to TOPical Treatment and a medical log. Other measures included the Brief Symptoms Inventory (BSI) for psychopathological symptoms and the Portuguese version of the self-administered psoriasis area and severity index for the patient’s severity self-assessment. A sociodemographic and clinical questionnaire was used to collect data on age, gender, marital status, education, professional status, family unit, psoriasis family history, disease duration, daily life changes due to psoriasis, workdays of absence per year, comorbidity, anxiolytic or antidepressant medication, and a social impact of psoriasis.

After the topical treatment, 35.6% (n = 36) of patients presented mild psoriasis, 51.5% (n = 52) had moderate psoriasis, 10.9% (n = 11) had severe psoriasis, and 2% (n = 2) were in remission.

Unlike previous studies finding non-adherence linked to psychosocial factors, Teixeira and colleagues found sociodemographic factors had a statistically significant effect on treatment adherence.

“This difference in the results may be related to the fact that the methodologies for measurement adherence could be distinct,” investigators explained.

Explanatory models showed positive associations between adherence and higher education (P = .03), the single-family household (P = .01), active employment status (P = .05), family history of psoriasis (P = .04), and the presence of obsessive-compulsive symptoms (P = .01).

The model estimated patients with low levels of education, who lived in households with ≥ 2 family members, and who were in an inactive profession have 76.4% lower odds of adhering to the therapy than patients with higher education, living in single-family households, and active employment status. The model suggests a single-family household impacts topical treatment adherence the most.

“One explanation for these results may be related to the fact that subjects who live alone have more time available to themselves to perform the daily application of topical treatments commonly used in psoriasis, often multiple times,” investigators wrote.

In contrast, education level is the factor with the lowest impact. As for active employment status, investigators explained this could be because these individuals “need to be at their best from an aesthetic point of view” and are therefore more likely to keep up with the treatment.

Additionally, people with obsessive-compulsive symptoms often strive for perfection, control, and are concerned with image, so this may explain the positive association between treatment adherence. Patients with a family history of psoriasis are more likely to adhere to treatment because relatives can educate them on the treatment outcomes.

Some limitations investigators outlined included self-reported measures, most patients recruited in hospital units (69.1), and the high experimental mortality (39.6%) which reduced the sample size.

“In concordance with our results that indicate the important role of the level of education on adherence, future research on evaluating the influence of interventions to improve health literacy on treatment adherence could be relevant—through an integrated approach with different health professionals (e.g., doctors, pharmacists, nurses, psychologists),” investigators concluded.

References

1. ^{Teixeira A, Teixeira M, Gaio R, Torres T, Magina S, Dinis MAP, Sousa-Lobo J, Almeida I, Peixoto M, Almeida V. Influence of Clinical and Psychosocial Factors on the Adherence to Topical Treatment in Psoriasis. Healthcare. 2024; 12(8):822. https://doi.org/10.3390/healthcare12080822}
2. ^{Soleymani T, Reddy SM, Cohen JM, Neimann AL. Early Recognition and Treatment Heralds Optimal Outcomes: the Benefits of Combined Rheumatology-Dermatology Clinics and Integrative Care of Psoriasis and Psoriatic Arthritis Patients. Curr Rheumatol Rep. 2017;20(1):1. Published 2017 Nov 20. doi:10.1007/s11926-017-0706-0}