THE ROLE OF NURSING EDUCATION IN ENHANCING MEDICATION ADHERENCE AMONG PATIENTS WITH CHRONIC INFLAMMATORY BOWEL DISEASES

Abstract

Chronic inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, represent a group of lifelong relapsing-remitting gastrointestinal conditions that significantly impair patients' quality of life and demand complex, long-term treatment regimens. Despite the availability of advanced pharmacological therapies, non-adherence to treatment remains a persistent challenge, contributing to disease flares, hospitalizations, and increased healthcare costs. Among various contributing factors, lack of patient education and insufficient communication between healthcare providers and patients stand out as key barriers to sustained medication adherence. This master’s thesis explores the role of nursing-led educational interventions in improving medication adherence among patients with IBD and evaluates the effectiveness of structured nursing education in fostering treatment commitment and self-management. The primary aim of this study is to assess whether educational support delivered by nurses can improve treatment adherence among individuals living with chronic inflammatory bowel diseases. The research is guided by several core objectives: (1) to determine baseline awareness and adherence levels in patients with IBD, (2) to identify gaps in patient knowledge and reasons for non-compliance, (3) to develop and implement a structured educational intervention by nursing staff, (4) to measure the impact of this intervention on adherence and patient-reported outcomes, and (5) to propose recommendations for integrating educational programs into routine nursing care. A quantitative-qualitative mixed-methods design was employed. The study included 60 patients diagnosed with IBD (30 with Crohn’s disease and 30 with ulcerative colitis), recruited from a regional outpatient gastroenterology clinic. Participants were assessed at baseline using validated questionnaires: the Morisky Medication Adherence Scale (MMAS-8), the IBD Knowledge Questionnaire, and a quality-of-life index (IBDQ-9). Following initial assessment, participants received a standardized nursing-led educational program, including one-on-one counseling, printed materials, and follow-up sessions over 3 months. Post-intervention assessments were conducted using the same tools to evaluate changes in adherence, knowledge, and overall satisfaction. The results revealed a statistically significant improvement in medication adherence post-intervention (p < 0.01), with mean MMAS-8 scores rising from 5.1 to 7.3. Patient knowledge scores increased by 42%, while quality-of-life indicators improved by 26%. Furthermore, qualitative feedback highlighted increased confidence in self-management, stronger nurse-patient relationships, and greater understanding of long-term treatment goals. A subgroup analysis suggested that individualized educational support was more effective in younger patients and those with recent diagnoses. This study confirms that structured educational interventions delivered by trained nursing professionals can substantially enhance medication adherence and empower patients with chronic inflammatory bowel diseases. The findings emphasize the necessity of integrating tailored educational strategies into nursing practice, especially in ambulatory settings where long-term care is coordinated. It also reinforces the critical role of nurses not only as caregivers, but as educators and advocates who bridge the knowledge gap and support patient-centered care. In conclusion, this research contributes to the evidence base advocating for expanded roles of nursing staff in managing chronic illnesses. Future studies should explore long-term sustainability of such interventions, scalability across different healthcare systems, and integration of digital educational tools to enhance reach and accessibility. Abbreviations used throughout the thesis include IBD – Inflammatory Bowel Disease; MMAS – Morisky Medication Adherence Scale; IBDQ – Inflammatory Bowel Disease Questionnaire; UC – Ulcerative Colitis; CD – Crohn's Disease.