A qualitative study of medication adherence amongst people with schizophrenia

Lucinda Clifford; Shona Crabb; Deborah Turnbull; Lisa Hahn; Cherrie Galletly

doi:10.1016/j.apnu.2020.06.002

A qualitative study of medication adherence amongst people with schizophrenia

Arch Psychiatr Nurs. 2020 Aug;34(4):194-199. doi: 10.1016/j.apnu.2020.06.002. Epub 2020 Jun 6.

Authors

Lucinda Clifford¹, Shona Crabb², Deborah Turnbull³, Lisa Hahn⁴, Cherrie Galletly⁵

Affiliations

¹ The University of Adelaide, North Terrace, Adelaide 5005, SA, Australia.
² School of Public Health, The University of Adelaide, 57 North Terrace, Adelaide 5000, SA, Australia.
³ School of Psychology, The University of Adelaide, Hughes, North Terrace, Adelaide 5005, SA, Australia.
⁴ Ramsay Health Care (SA) Mental Health, 33 Park Terrace, Gilberton, Adelaide 5081, SA, Australia.
⁵ The University of Adelaide, North Terrace, Adelaide 5005, SA, Australia; Ramsay Health Care (SA) Mental Health, 33 Park Terrace, Gilberton, Adelaide 5081, SA, Australia; Northern Adelaide Local Health Network, Haydown Road, Elizabeth Vale, Adelaide 5112, SA, Australia. Electronic address: cherrie.galletly@adelaide.edu.au.

PMID: 32828348
DOI: 10.1016/j.apnu.2020.06.002

Abstract

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.

Keywords: Adherence; Antipsychotic medication; Non-adherence; Qualitative research; Schizophrenia.

MeSH terms

Adult
Antipsychotic Agents* / adverse effects
Antipsychotic Agents* / therapeutic use
Australia
Female
Grounded Theory
Humans
Independent Living*
Interviews as Topic
Male
Medication Adherence*
Physician-Patient Relations*
Qualitative Research
Recurrence
Schizophrenia / drug therapy*

Substances

Antipsychotic Agents