Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with patients' perspectives.

To explore patients' agreement and reasons for agreement or disagreement with the EULAR recommendations for patient education (PE) for people with inflammatory arthritis (IA). This mixed-method survey collected data using snowball sampling. The survey had been translated into 20 languages by local healthcare professionals, researchers and patient research partners. It explored the degree to which patients with IA agreed with each recommendation for PE (0=do not agree at all and 10=agree completely) and their rationale for their agreement level in free text questions. Descriptive statistics summarised participants' demographics and agreement levels. Qualitative content analysis was used to analyse the free text data. Sixteen subcategories were developed, describing the reasons for agreement or disagreement with the recommendations, which constituted the categories. The sample comprised 2779 participants (79% female), with a mean (SD) age 55.1 (13.1) years and disease duration 17.1 (13.3) years. Participants strongly agreed with most recommendations (median 10 (IQR: 9-10) for most recommendations). Reasons for agreement with the recommendations included the benefit of using PE to facilitate collaborative care and shared decision making, the value of flexible and tailored PE, and the value of gaining support from other patients. Reasons for disagreement included lack of resources for PE, not wanting information to be tailored by healthcare professionals and a reluctance to use telephone-based PE. The EULAR recommendations for PE have been disseminated among patients with IA. Overall, agreement levels were very high, suggesting that they reflect patients' preferences for engaging in collaborative clinical care and using PE to facilitate and supplement their own understanding of IA. Reasons for not completely agreeing with the recommendations can inform implementation strategies and education of healthcare professionals.

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Competing interests: All authors have completed the ICMJE form for Competing Interests Disclosure and report a research grant from European Alliance of Associations for Rheumatology (EULAR) during the conduct of the study; SB and MN have received speaking fees from CCIS – The Conference Company for speaking at the Irish Rheumatology Nurses Forum meeting. MF reports consulting fees from Janssens Pharmaceuticals, and speaking fees from Janssen pharmaceuticals, Pfizer Inc, Ono Pharmaceuticals, Bristol Myers Squibb, Chugai Pharmaceuticals and Abbvie, all outside the submitted work. BJ reports personal honoraria from Lily UK for speaking at an Expert Webinar, outside the submitted work. EM reports Consulting fees from Boehringer Ingelheim Portugal and LPCDR received grants from Abbvie, Novartis, Pfizer, Lilly Portugal, Amgen Biofarmacêutica, Grünenthal SA, MSD, Medac and from A. Menarini Portugal - Farmacêutica, SA; and support for attending meetings from Pfizer, Lilly Portugal and Grünenthal GmbH. MV reports an educational grant from Pfizer for PhD study, outside the submitted work. IL, HZ, CB, KVdE, FF, MdCHM, JH, MLK, SKK, PM, TN, MPN, JP, RR, MS, MS, EW and AvT report no conflicts of interest. No financial relationships with any organisations that might have an interest in the submitted work in the previous 36 months; no other relationships or activities that could appear to have influenced the submitted work.