Operationalizing Clinical Competence among Occupational Physicians: Three Domains and Five Cross-Cutting Processes Identified by Reflexive Thematic Analysis.

Ankylosing spondylitis is a chronic inflammatory disease primarily affecting the axial skeleton. Its hallmark features—inflammatory low back pain, bony ankylosis, and spinal new bone formation—lead to progressive loss of spinal mobility, physical limitation, and a substantial decline in quality of life as the disease advances. Diagnosis is established according to the modified New York criteria. A notable challenge is the diagnostic delay of 5–10 years that typically elapses between symptom onset and confirmed diagnosis, underscoring the urgency of early recognition and adherence-focused education. Successful AS management depends to a considerable degree on sustained patient engagement with long-term treatment plans, encompassing regular follow-up visits and consistent adherence to prescribed regimens. Poor adherence is associated with higher disease activity, worsening symptoms, and deteriorating overall health. Biological agents (BAs) have been shown to meaningfully improve health-related quality of life (HRQoL) in AS patients, which underscores the connection between good adherence and favorable clinical outcomes (). Moreover, when patients actively participate in treatment decisions and are well-informed about the efficacy and safety profiles of BAs, adherence tends to improve substantially. The determinants of treatment adherence in AS are multidimensional. Psychological conditions such as anxiety and depression are closely linked to reduced adherence (); socioeconomic constraints, including limited income and restricted access to healthcare, present additional barriers; illness perception and disease-related stigma add to patients’ psychological burden and frequently discourage care-seeking. Conversely, adequate disease knowledge promotes adherence by encouraging patients to take their health more seriously, while effective support from healthcare professionals and constructive patient–provider communication further reinforce adherence behaviors ().