The outcome of patients with rheumatic disease, in particular rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) is variable and often unpredictable, and important differences have been observed across racial groups. Patients often show poor adherence to therapy, but the determinants and outcomes of compliance-related behaviors have not been adequately documented. We hypothesize that some of the ethnic differences in the outcome of these diseases may be related to degree of compliance with physician recommendations. The overall objective of this study is to quantify adherence to medical recommendations in patients with RA and SLE from diverse ethnic backgrounds, and to determine which are its predictors and outcomes, with an emphasis on psychosocial factors and medical interaction issues. The study will: a) compare attitudes and behaviors toward adherence to treatment in patients with RA and SLE from diverse ethnic backgrounds; b) assess the role of patient beliefs, expectations and attitudes about their disease on their adherence to treatment; c) assess the role of selected elements of the medical interaction on patients' compliance; d) evaluate ethnic differences in compliance in the context of a modified Health Belief Model (HBM); and e) determine the impact of non-compliance on patient outcomes. Phase I will use focus groups (including White, Hispanic, and Black patients) to explore the views of patients with RA and SLE toward adherence to treatment, barriers and perceived benefits. The groups will also provide information to develop scales that measure barriers and expectations in the context of the HBM. Phase 2 will be a 2-year cohort study of patients with RA and SLE from diverse ethnic backgrounds which will evaluate the determinants of adherence to treatment on the basis of the HBM, and will also examine health outcomes at the end of the 2 years according to the degree of adherence.
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