A Theoretical Model of Patient Adherence in Psoriasis Treatment Management

Thesis Abstract

Patient adherence to psoriasis treatment remains a persistent challenge, significantly impacting clinical outcomes and healthcare costs. Despite the availability of effective therapies, suboptimal adherence rates undermine treatment efficacy, emphasizing the need for a comprehensive understanding of the behavioral and psychosocial factors influencing patient compliance. This study aims to develop a robust theoretical model that explicates the determinants of patient adherence in psoriasis management, integrating behavioral science and health psychology frameworks to guide targeted interventions. The specific objectives include identifying key psychosocial, demographic, and treatment-related factors that predict adherence; exploring patients’ perceptions, beliefs, and motivations regarding psoriasis treatment; and constructing an explanatory model illustrating the interactions among these variables. The study adopts a mixed-methods research design, whereby quantitative data are collected through structured questionnaires and qualitative insights obtained via semi-structured interviews. The target population comprises adult patients diagnosed with psoriasis attending dermatology clinics in a metropolitan area, with a sample size of 400 participants for the quantitative component, selected through stratified random sampling to ensure representativeness across age, gender, and disease severity. An additional 20 participants will be purposively sampled for in-depth interviews to explore nuanced perspectives on adherence behaviors. Data collection instruments include a validated adherence measurement scale, such as the Morisky Medication Adherence Scale (MMAS-8), alongside a composite questionnaire capturing psychosocial variables based on the Theory of Planned Behavior and Health Belief Model constructs. The reliability and validity of instruments will be tested using Cronbach’s alpha and confirmatory factor analysis, respectively. Quantitative data will be analyzed using multiple regression analysis to identify significant predictors of adherence, supplemented by structural equation modeling (SEM) to establish the proposed relationships among variables within the theoretical framework. Qualitative data will undergo thematic analysis to uncover underlying themes related to patient perceptions and barriers. This integrative approach aims to validate and refine the proposed theoretical model, which conceptualizes adherence as a function of individual beliefs, social influences, perceived severity and susceptibility, self-efficacy, and treatment convenience. It is anticipated that the findings will reveal complex interactions among psychosocial and demographic factors, with significant predictors including health-related beliefs, perceived social support, and perceived control over treatment outcomes. The analysis expects to confirm the applicability of integrating the Theory of Planned Behavior with the Health Belief Model in explaining adherence behaviors among psoriasis patients. The study will contribute to existing knowledge by providing a comprehensive, evidence-based model that elucidates the multifactorial nature of adherence and offers a foundation for designing tailored interventions to improve compliance. The main conclusion underscores the critical need to address psychosocial perceptions and social influences in psoriasis management strategies. It is recommended that healthcare providers incorporate patient-centered communication and motivational interviewing techniques to reinforce positive beliefs and facilitate adherence. Policy-wise, integrating adherence-promoting tools within disease management programs and patient education initiatives is advisable. Future research should examine the applicability of the developed model across diverse populations and explore longitudinal assessments of adherence behaviors. Overall, this study advances theoretical understanding and offers practical insights necessary to enhance treatment outcomes in psoriasis care through improved adherence strategies.