{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:16:21Z","timestamp":1787505381146,"version":"build-2736575974"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ulcerative colitis is an inflammatory bowel disease that is limited to the colon. First-line treatment consists of rectally administered suppositories, foam or enema. Adherence to rectal treatment is very low in people with ulcerative colitis. We aimed to explore modifiable factors influencing adherence to rectal treatment among patients, healthcare providers (HCP), and pharmaceutical companies, and to delineate new approaches to improve adherence to rectal medicines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We recruited people using rectal treatment, community and clinical pharmacists, gastroenterologists, inflammatory bowel diseases (IBD) nurses, and representatives of pharmaceutical companies specialised in the production of rectal therapies. We performed semi-structured one-to-one interviews tackling the three pivotal topics knowledge and beliefs, product characteristics, and communication. We started with patient interviews whose statements served to inform the other interviews. All interviews were the subject of a keyword protocol, audio-recorded, and transcribed. Thematic analysis was used with inductive approach for the patients, and deductive approach for all other interviewees. Identified themes were compared and agreements and divergences were compiled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We interviewed eight patients (22\u201377 years old, 3 women) in spring 2023, and stakeholders from the hospital (3 gastroenterologists and 2 IBD nurses), ambulatory setting (4 community pharmacists) and pharmaceutical companies (2 representatives) in 2024, all in the region of Basel (Switzerland). Overall, people with ulcerative colitis often feel left alone to cope with the challenges associated with their therapies. Pretreatment concerns and difficulties experienced by these people following their first attempts at use are not adequately addressed by HCPs. Training sessions for clinicians and pharmacists, patient-oriented demonstration materials, visual aids, and tips and tricks the application of rectal treatment could help improve the use of rectal medicines by people with ulcerative colitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified a detailed knowledge of the proper use of rectal treatment and frank communication between patients and HCPs as crucial for the adherence to rectally administered medicines. While these factors are broadly recognised in the literature, this study highlights their common priority among all stakeholders. In addition, solutions for future development and tailored interventions are proposed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2025.1654520","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T05:49:44Z","timestamp":1759297784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Rectal treatment in ulcerative colitis; a qualitative study exploring reasons for under utilisation"],"prefix":"10.3389","volume":"5","author":[{"given":"Jean-Pierre","family":"Rothen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Moerlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"von B\u00fcren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Allemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Arnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5A","DOI":"10.1155\/2005\/269076","article-title":"Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal world congress of gastroenterology","volume":"19","author":"Silverberg","year":"2005","journal-title":"Can J Gastroenterol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/ecco-jcc\/jjab178","article-title":"ECCO guidelines on therapeutics in ulcerative colitis: medical treatment","volume":"16","author":"Raine","year":"2022","journal-title":"J Crohns Colitis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1053\/j.gastro.2018.12.009","article-title":"Aga clinical practice guidelines on the management of mild-to-moderate ulcerative colitis","volume":"156","author":"Ko","year":"2019","journal-title":"Gastroenterology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.crohns.2013.03.005","article-title":"Topical therapy is underused in patients with ulcerative colitis","volume":"8","author":"Seibold","year":"2014","journal-title":"J Crohns Colitis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.1093\/ibd\/izz059","article-title":"The role of early biologic therapy in inflammatory bowel disease","volume":"25","author":"Berg","year":"2019","journal-title":"Inflamm Bowel Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1097\/01.mib.0000231495.92013.5e","article-title":"Medical management of left-sided ulcerative colitis and ulcerative proctitis: critical evaluation of therapeutic trials","volume":"12","author":"Regueiro","year":"2006","journal-title":"Inflamm Bowel Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1159\/000341947","article-title":"Topical therapies in inflammatory bowel disease","volume":"86","author":"Frei","year":"2012","journal-title":"Digestion"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1097\/MIB.0000000000000562","article-title":"Adherence to rectal mesalamine in patients with ulcerative colitis","volume":"21","author":"Boyle","year":"2015","journal-title":"Inflamm Bowel Dis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1111\/j.1365-2036.2007.03555.x","article-title":"Risk factors for non-adherence to medication in inflammatory bowel disease patients","volume":"27","author":"D'Inca","year":"2008","journal-title":"Aliment Pharmacol Ther"},{"key":"B10","doi-asserted-by":"publisher","first-page":"297","DOI":"10.2147\/PPA.S127039","article-title":"Adherence in ulcerative colitis: an overview","volume":"11","author":"Testa","year":"2017","journal-title":"Patient Prefer Adherence"},{"key":"B11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/s0002-9343(02)01383-9","article-title":"Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis","volume":"114","author":"Kane","year":"2003","journal-title":"Am J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ibd\/izz104","article-title":"The cost of inflammatory bowel disease: an initiative from the Crohn\u2019s & Colitis foundation","volume":"26","author":"Park","year":"2020","journal-title":"Inflamm Bowel Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1007\/s10620-007-9968-0","article-title":"Medication non-adherence is associated with increased medical health care costs","volume":"53","author":"Kane","year":"2008","journal-title":"Dig Dis Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"805","DOI":"10.12968\/bjon.2020.29.14.805","article-title":"Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence","volume":"29","author":"Naeck-Boolauky","year":"2020","journal-title":"Br J Nurs"},{"key":"B15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3390\/pharmacy13010021","article-title":"Medication non-adherence in inflammatory bowel disease: a systematic review identifying risk factors and opportunities for intervention","volume":"13","author":"King","year":"2025","journal-title":"Pharmacy"},{"key":"B16","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3390\/pharmacy10020043","article-title":"Exploring a new theoretical model to explain the behavior of medication adherence","volume":"10","author":"Unni","year":"2022","journal-title":"Pharmacy"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3489","DOI":"10.1038\/s41467-023-39013-3","article-title":"Temperature-triggered in situ forming lipid mesophase gel for local treatment of ulcerative colitis","volume":"14","author":"Carone","year":"2023","journal-title":"Nat Commun"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1093\/ibd\/izy013","article-title":"Revealing the puzzle of nonadherence in IBD-assembling the pieces","volume":"24","author":"Eindor-Abarbanel","year":"2018","journal-title":"Inflamm Bowel Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s11096-022-01470-z","article-title":"Association between health literacy and medication adherence in chronic diseases: a recent systematic review","volume":"45","author":"Hyvert","year":"2023","journal-title":"Int J Clin Pharm"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1002\/ibd.21570","article-title":"Impact of a tailored patient preference intervention in adherence to 5-aminosalicylic acid medication in ulcerative colitis: results from an exploratory randomized controlled trial","volume":"17","author":"Moshkovska","year":"2011","journal-title":"Inflamm Bowel Dis"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2025.1654520\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T05:49:45Z","timestamp":1759297785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2025.1654520\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":21,"alternative-id":["10.3389\/frhs.2025.1654520"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2025.1654520","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"article-number":"1654520"}}