Patients' Beliefs on the Causes of Inflammatory Bowel Disease in the Addressing Disability Effectively With Psychosocial Telemedicine (ADEPT) Trial

Background:
Illness perceptions are the cognitive and emotional meanings that patients attach to their disease. A key component of illness perceptions is causal beliefs, which can shape how to adjust to living with a chronic illness, cope with the disease, and approach therapeutic options. Understanding patients’ causal beliefs allows physicians to better align therapies and resources with patients’ priorities.
Methods:
In this multicenter, observational study, adult IBD patients were enrolled from 5 gastroenterology practices participating in the Addressing Disability Effectively with Psychosocial Telemedicine (ADEPT) Trial (NCT05635292). We solicited patients’ beliefs on the top 3 perceived causes of IBD using the ranked-order free-text item on the Brief Illness Perception Questionnaire (BIPQ). The BIPQ is a 9-item self-reported measure that elicits patients’ cognitive and emotional representations of their illness. We performed inductive thematic analysis to identify emergent codes and create a codebook for patient responses, coded by 2 researchers with high inter-rater reliability (mean percentage agreement 92%, SD = 5.4%). We used χ² (p < .05) and logistic regression to explore further the association between patients’ demographics and IBD characteristics with their causal beliefs of IBD.
Results:
Patients (n&#x3d;615) most often believed that IBD was caused by stress (64%), diet (56%), genetics (49%), lifestyle (19%; including sleep, exercise, substance use), or a consequence of another illness or medical event (15%; e.g., comorbid disease, medication, or pregnancy). Other causal beliefs less commonly identified (&#x3c; 5.4%) included the environment, immunity, idiopathic, gut health, and age. Female patients were more likely to believe that IBD was caused by stress (OR 1.7, 95% CI 1.2-2.4, p &#x3c; .01) or another illness or medical event (OR 1.9, 95% CI 1.2-3.2, <italic>P &#x3d;</italic> 0.0123). Patients with higher education degrees were more likely to believe genetics (OR 1.7, 95% CI 1.2-2.5, &#x3c; .01) and stress (OR 1.9, 95% CI 1.3-2.7, p &#x3c; .01) as causes of IBD. No significant differences were found in the demographics of patients who believed in diet or lifestyle as causes of their IBD.
Conclusions:
Aligned with research on the complex causes of IBD, patients most commonly believe that IBD is caused by stress, diet, and genetics. Targeting these beliefs with resources for psychosocial support and dietitian consultations can help providers connect with patients after diagnosis. Future research is needed about how illness perceptions in IBD can shape treatment plans to improve patient care.