Families and medication use and adherence among Latinos with schizophrenia

Abstract

Background Medication nonadherence among Latinos with schizophrenia represents a significant treatment obstacle. Although some studies have examined patient and family perceptions of adherence, few have examined these perceptions together. However, such knowledge can provide a deeper understanding of how family processes may contribute to or impede adherence among underserved groups such as Latinos. Aims This study explored perceptions of medication and adherence among Latinos with schizophrenia and key family members. Method Purposive sampling was used to collect data from 34 participants: 14 patients with schizophrenia receiving community-based mental health services in an urban public setting and 20 key family members. Informed by grounded theory, semistructured interviews were analyzed by bilingual–bicultural team members. Results Salient themes emerged indicating facilitators of and obstacles to medication use. Specifically, challenges centered on medication side effects, autonomy and choice, and illness insight, whereas facilitators focused on family support and holistic views of treatment and empowerment. Conclusions Because the majority of Spanish-speaking Latinos with schizophrenia live with family, it is important to examine family factors that may influence medication use. Findings suggest that patient and family perceptions of medication should be examined as part of the treatment process, particularly regarding issues of autonomy and choice.

Medication nonadherence among South American patients with schizophrenia

“…In relation to this last point, as found by a recent study, it is likely that patients who struggled with medication had a difficult time acknowledging their illness. 18 On the other hand, several factors did not remained significant after adjustment such as country, monthly family income, more severe psychotic symptomatology, type of mental health treatment, and side effects.…”

“…The association between lack of insight and poor adherence has been extensively confirmed in previous studies. 11 , 18 , 58 – 62 This finding suggests that clinicians should enhance the detection of this problem of insight in Latin American countries and try to modify attitudes toward medication in SZ patients, especially by exploring and addressing concerns and patients’ distrust in pharmacotherapy. 59 Previous studies reported the importance of respecting and considering patients’ belief systems to improve medication attitudes.…”

“…Nonadherence to pharmacological treatment in patients with SZ is a complex phenomenon summarized into the following four factors: sociodemographic variables; variables related with the disorder itself; variables related to treatment (frequency and intensity of side effects, insight, comorbid addiction, and duration of treatment); and finally, variables that have to do with the values and attitudes of the patient (attitude toward the disease). 15 – 18 …”

Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research

“…(Zou et al, 2014, p. 358) The Need for Guidance Because of difficulties in performing self-management tasks (see Table 3) independently, participants expressed the need for guidance (Aref-Adib et al, 2016;Chronister et al, 2015;Ouwehand et al, 2014). Participants stated difficulties in understanding and recalling information (Aref-Adib et al, 2016), thinking logically, making decisions (Fisher et al, 2017), being proactive (Doherty & MacGeorge, 2013;Fisher et al, 2017), making one's voice heard (Fisher et al, 2017;Topor et al, 2006), and expressing oneself (Aref-Adib et al, 2016;Hernandez & Barrio, 2017;Rusner et al, 2010). These difficulties were related to a lack of confidence, learning disabilities (Aref-Adib et al, 2016), unawareness of current symptoms (Chronister et al, 2015;Doherty & MacGeorge, 2013;Whitley & Campbell, 2014;Zou et al, 2013), a fear of what might happen (Ouwehand et al, 2014;Poremski et al, 2016;Rusner et al, 2010;Zou et al, 2013), or being overwhelmed (Aref-Adib et al, 2016;Chronister et al, 2015;Fisher et al, 2017;O'Connor et al, 2008;Ouwehand et al, 2014;Rusner et al, 2010).…”

<p>Adherence to Antipsychotic Medication and Quality of Life in Latin-American Patients Diagnosed with Schizophrenia</p>

“…10,11 Non-adherence is considered a complex phenomenon, which could be influenced by four factors: sociodemographic variables, psychotic symptomatology (including persecutory delusion, hostility, and cognitive impairment), variables related to treatment (frequency and intensity of side effects, subjective feeling under treatment, comorbid addiction, duration of treatment, and addictive behavior), and insight into the disorder. [12][13][14][15] Quality of life (QoL) is severely impaired in patients diagnosed with schizophrenia. 16 QoL and adherence to antipsychotics in patients have been studied extensively and independently.…”