Medication Adherence in Schizophrenia: Exploring Patients', Carers' and Professionals' Views

TLDR

Suboptimal medication adherence is a major clinical problem in schizophrenia, yet most studies use quantitative methods that inadequately capture patients’ decision‑making processes. This study explores factors influencing medication adherence behavior in schizophrenia using concept mapping. Concept mapping, a structured qualitative method, was conducted with 27 patients, 29 carers, and 28 professionals across four European countries. Five clinically relevant themes—medication efficacy, external factors such as support and therapeutic alliance, insight, side effects, and attitudes—were identified, with importance ratings varying among professionals, carers, and patients, indicating a lack of shared understanding and suggesting that focusing on positive medication aspects, insight, and therapeutic relationships may improve adherence.

Abstract

One of the major clinical problems in the treatment of people with schizophrenia is suboptimal medication adherence. Most research focusing on determinants of nonadherence use quantitative research methods. These studies have some important limitations in exploring the decision-making process of patients concerning medication. In this study we explore factors influencing medication adherence behavior in people with schizophrenia using concept mapping. Concept mapping is a structured qualitative method and was performed in 4 European countries. Participants were 27 patients with schizophrenia, 29 carers, and 28 professionals of patients with schizophrenia. Five clinically relevant themes were identified that affect adherence: medication efficacy, external factors (such as patient support and therapeutic alliance), insight, side effects, and attitudes toward medication. Importance ratings of these factors differed significantly between professionals and carers and patients. Professionals, carers, and patients do not have a shared understanding of which factors are important in patients' medication adherence behavior. Adherence may be positively influenced if professionals focus on the positive aspects of medication, on enhancing insight, and on fostering a positive therapeutic relationship with patients and carers.