A qualitative study of medication adherence amongst people with schizophrenia [2020]

• Non-adherence to antipsychotic medication is associated with an increased risk of relapse

• Gaining insight from negative past experiences is a learning process and improves adherence

• Side effects of antipsychotic medication impact on adherence

• The role of peer workers and collaboration plays an important role in continuing medication

• The voice of the patient in helping drive their own treatment, needs to be considered in a clinical setting

• Cycles of medication adherence, cessation, relapse and recovery is an ongoing learning experience

Non-adherence to antipsychotic medication is common among people with schizophrenia, and is associated with an increased risk of relapse. It is important to develop strategies to enhance medication adherence. Few qualitative studies have been undertaken to understand the consumer’s perspective. The voice of people who are prescribed these medications is therefore missing from the research literature. Reasons for non-adherence were investigated by directly engaging with consumers and exploring their attitudes, beliefs and experiences concerning antipsychotic medications. Qualitative, semi- structured, one-to-one interviews were conducted with 25 community-dwelling people with schizophrenia from metropolitan Adelaide, Australia. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers’ attitudes and experiences with medication. Interviews continued until there was saturation of themes. Consumer-related factors, medication-related factors and service-related factors were reported to influence adherence behavior. These included poor insight, unpleasant medication side effects, inadequate efficacy and poor therapeutic alliance. Lessons gained during periods of non-adherence were the motivator for future adherence; such as worsening of symptoms if medication was not taken. Potential implications of future adherence described by Interviewees include greater involvement of peer workers, as they were considered to work more effectively with consumers to encourage adherence. Peer workers had more credibility than other service providers due to their lived experience. Multiple factors were identified that impact on antipsychotic medication adherence, providing opportunities for interventions and improvements in services that would enhance adherence.

Lucinda Clifford, Shona Crabb, Deborah Turnbull, Lisa Hahn, Cherrie Galletly
Archives of Psychiatric Nursing, Volume 34, Issue 4, August 2020