Frequency, barriers and facilitators of adherence to treatment among people with systemic lupus erythematosus in China: a scoping review.

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease requiring long-term therapy, where adherence critically impacts outcomes. Non-adherence remains a significant barrier to disease control, particularly in China, where healthcare disparities persist. This scoping review aimed to systematically map the existing evidence on the frequency, barriers and facilitators of treatment adherence among Chinese patients with SLE and to identify gaps to guide future research and interventions. We included studies that assessed adherence to pharmacological and/or non-pharmacological SLE treatments among Chinese adults (≥18 years). Eligible designs included observational, interventional, qualitative and mixed-method studies published in English or Chinese. 10 electronic databases (eg, CNKI, PubMed, Web of Science, SCOPUS) were searched from inception to 27 March 2024, using MeSH terms and relevant keywords. Additional studies were retrieved through manual reference screening. Data were extracted using a standardised form informed by the WHO multidimensional adherence framework. Key variables included study design, adherence measurement tools, frequency and categorised barriers/facilitators. Data were charted independently by two reviewers. 21 studies met inclusion criteria. Adherence was most often measured via self-report, especially Morisky Medication Adherence Scale-8 and Compliance Questionnaire for Rheumatology. Non-adherence ranged from 33.3% to 75.0%, reflecting measurement and population heterogeneity. Barriers were commonly patient-related, treatment-related and system-related, including fear of side effects, complex regimens, poor communication and financial burden. Facilitators included structured education, psychological support, simplified regimens and family support. Treatment adherence among Chinese SLE patients is suboptimal and influenced by multidimensional factors. Culturally tailored, multilevel interventions-addressing education, communication and system-level barriers-are urgently needed. Adoption of standardised adherence measures and use of the WHO framework can improve cross-study comparability and guide targeted interventions. OSF: osf.io/x5uzc; DOI: https://doi.org/10.17605/OSF.IO/GQWA7.