The Pendulum of Adherence: An Interpretative Phenomenological Analysis of Psoriasis Treatment Discontinuation

Psoriasis is a chronic, immune-mediated skin disorder requiring lifelong management, yet maintaining treatment adherence remains a significant challenge. Frequent treatment discontinuation often results in disease recurrence and poorer health outcomes, highlighting the need for a comprehensive understanding of psoriasis patients' lived experiences concerning treatment adherence.

A phenomenological research approach was employed to explore psoriasis patients' lived experiences concerning treatment adherence. Semi-structured, in-depth interviews were conducted with 16 participants, all discontinued and later resumed treatment. Data were analyzed using interpretative phenomenological analysis (IPA) to identify key themes shaping treatment adherence. Bronfenbrenner's Process-Person-Context-Time (PPCT) model was also applied to elucidate the underlying mechanisms influencing treatment adherence.

Findings revealed four Group Experiential Themes (GETs) associated with treatment discontinuation: Healthcare Instability, Loss of Faith in Treatment, Financial Strain, and Concerns About Side Effects. Five GETs emerged as motivators for resuming treatment: Hope in New Therapies, Stigma and Social Pressure, Severe Symptom Relapse, Financial Relief, and Support from Healthcare Professionals.

This study systematically uncovers the complex factors influencing psoriasis treatment adherence. Applying phenomenology and the PPCT model illustrates the dynamic interplay between individual and environmental influences that shape psoriasis patients treatment adherence. A patient-centred, community-based, and adaptive approach is essential to bridging the gap between clinical recommendations and real-world treatment adherence, thereby improving long-term disease management and enhancing psoriasis patients' quality of life.