Adherence as a lifetime effort.

The purpose of the study is to improve recall of information and medication adherence of IBD patients who receive a medication change to immunosuppressive drug classes used for long-term maintenance therapy. Specific aims are:

1. To examine the extent to which communication during the medical consultation is tailored to patients' needs;

2. To examine which communication techniques concerning promoting recall and adherence are used by IBD nurses and;

3. To examine patients' use of additional information sources;

4. To develop recommendations to tailor the communication process to the patients’ needs and improve recall of information and adherence;

5. To implement an intervention, existing of a communication skills training combined with a web based application, based on these recommendations and;

6. To evaluate the effectiveness of this intervention.

Data collection will be in the Netherlands.

Medication represents a keystone of modern treatment strategies for Inflammatory Bowel Disease (IBD). Appropriate use of the medication can help IBD patients to reduce the chance of relapse. Nevertheless, IBD patients represent a high-risk situation as it comes to non-adherence. Non-adherence rates have been described as varying from 20% - 40% and rises as high as 72% for long-term therapies Appropriate use of the medication can help IBD patients to reduce the change of relapse. Research shows that patients who are satisfied with their relation with their health care providers have better adherence. Clinical efforts to promote adherence depend on clinicians and nurses providing the message and patients being able to recall it, i.e. to be able to understand and reproduce the message. However, 40-80% of the medical information presented by health care is immediately forgotten by patients. There is a growing body of empirical evidence that demonstrates that addressing patients’ information needs (task oriented communication) and emotional needs (socio-emotional communication) will result in better recall and, consequently, might improve treatment adherence. Therefore, effective communication is crucial and patients’ recall of advice is an intermediary step to action to maintain the medication-taking behaviour and promote treatment adherence.

1. Questionnaire 1 (before consultation nurse);

2. Consultation IBD-nurse (video-taped);

3. Questionnaire 2 (immediately after consultation nurse);

4. Questionnaire 3 (follow-up after 2 weeks by phone);

5. Questionnaire 4 (follow-up after 6 months by phone).

A nurse-based and a patient-centered (eHealth) intervention.

Based on the first study, an intervention will be developed. This intervention will consist of a tailored communication device (eHealth) and a communication skills training. The first experimental group of nurses will receive a communication skills training, the second experimental group will receive the same communication skills training added with a supportive eHealth intervention for patients and the control group will continue in giving care as usual. Concerning the communication skills training, this will be one day with a follow-up after 6 weeks. The reminder system will prompt the patient on the moment they should take the medication. This could be daily, once a week, once in two weeks or once in eight weeks, it will depend on the treatment regimen.