A Qualitative Exploration of Adherence to Methotrexate in Juvenile Idiopathic Arthritis

To identify barriers and facilitators of adherence to methotrexate (MTX) in juvenile idiopathic arthritis (JIA).

We conducted a qualitative cross-sectional study employing semistructured interviews of 20 adolescents with JIA with varying levels of MTX adherence, determined by pharmacy dispense data. We used grounded theory to identify common themes, which we organized into barriers and facilitators, subdivided into World Health Organization adherence domains.

The sample had equal representation of adherent and nonadherent patients, and of those prescribed oral and injectable MTX. The most common barriers were patient- or medication-related, including anticipatory nausea, anxiety, busy schedules, side effects, and the color, taste, and odor of MTX. Common facilitators included patient-related (reminders, routines, calming techniques, family, autonomy, time since diagnosis) and medication-related factors (autoinjectors, folic acid), as well as some health care system-related (positive clinic experiences), and socioeconomic factors (community medical knowledge).

Through interviews with adolescents on MTX for JIA and using the World Health Organization's framework, we gained valuable insight on the most salient barriers and facilitators of MTX adherence. These findings can inform interventions to improve medication adherence and optimize patients' quality of life.