Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model

Abstract

Background Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators. Purpose To examine the insight–medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude. Patients and Methods This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains. Results In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect. Conclusion In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients’ medication attitude may be more effective in improving medication adherence than merely enhancing insight.

Improving Medication Adherence among Patients with Schizophrenia in the Sunyani Municipality, Ghana: The Role of Therapeutic Alliance

“…The result of our study indicates that the mean score for MARS (4.56) was less than half the highest possible score for the scale (10). Although there is no absolute cutoff value for MARS, the mean score in our study is lower than those of similar studies that employed the same scale, in Korea (Chang et al, 2019), Oman (Maqbali et al, 2022) and Taiwan (Hsieh et al, 2022), where mean MARS scores were 6.8, 5.7, and 5.8 respectively. Our results, however, are consistent with the findings of previous research into medication adherence among mental health patients in SSA.…”

“…Central to the management of patients with schizophrenia is the clinician-patient relationship (therapeutic alliance) which has been found to significantly affect the treatment process and outcome (Hsieh et al, 2022). Therapeutic alliance refers to "a purposeful, goal-directed relationship between a clinician (doctor/nurse, or psychologist) and a patient that is directed at advancing the best interest of the patient and [their] health outcome" (Donald et al, 2022).…”

“…(Kareem & Mahmood, 2022). Poor adherence or nonadherence to antipsychotic medications accounts for most of the relapses in schizophrenia, resulting in several hospital readmissions, suicidal behaviours (Zacharia, 2022), violence (Hsieh et al, 2022), and poor cognitive, clinical and functional outcome (Tessier et al, 2017).…”

Alliance Thérapeutique Entre Les Patients Hospitalisés En Psychiatrie De Secteur Et Les Infirmier(e)s Et Aide-Soignant(e)s: Une Etude Prospective, Observationnelle Et Transversale

“…1 Elle favoriserait les effets de la psychothérapie, et augmenterait l’observance du traitement médicamenteux. 2–4…”

“…1 Elle favoriserait les effets de la psychothérapie, et augmenterait l'observance du traitement médicamenteux. [2][3][4] Dans la littérature, l'AT est majoritairement abordée dans le contexte d'une relation duale entre un clinicien et un patient. Peu de publications explorent l'AT prodiguée par un groupe de soignants, ce qui est le cas lors d'une hospitalisation.…”