Facilitators and barriers to medication adherence in systemic lupus erythematosus: a qualitative study in China

Medication adherence in systemic lupus erythematosus (SLE) remains suboptimal worldwide due to complex psychosocial and structural barriers. However, few studies have explored clinical experts' perspectives on facilitators and barriers to adherence, particularly within the Chinese healthcare context. This study aimed to explore clinical experts' perspectives on medication adherence among patients with SLE and to identify multidimensional factors influencing adherence. Semi-structured interviews were conducted with clinical experts and transcribed verbatim. Data were analysed using thematic analysis with NVivo 12. Themes were organized into five predefined dimensions: patient-related, disease-related, treatment-related, medical care-related, and socioeconomic-related factors. Each theme was classified as either a facilitator or a barrier. Visual analytic methods, including heatmaps, word clouds, frequency matrices, Sankey diagrams, and bipartite network graphs, were used to illustrate expert consensus and thematic relationships. A total of 38 themes were identified, including 18 facilitators and 20 barriers. All 16 experts identified symptom relief or mild disease, complex treatment regimens, distressing medication side effects, and high medication costs among the most frequently reported barriers. The most commonly reported facilitators included effectively managed side effects and personalized health education. Themes were unevenly distributed across dimensions, with a higher concentration of facilitators in medical care-related factors and a predominance of barriers within treatment-related factors. Variations in thematic emphasis may reflect differences in clinical roles and levels of patient engagement among experts. Medication adherence in patients with SLE is influenced by multiple interrelated factors. Improving adherence may benefit from comprehensive, multi-level strategies, including patient education, simplified treatment regimens, continuity of care, and supportive health policies.