Patient Preference and Adherence (Apr 2022)
Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model
Abstract
Wen Ling Hsieh,1 Shin Ting Yeh,2 Wen I Liu,1 I Hsien Li,1 Shih Kai Lee,3 Wai Tong Chien4 1School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; 2Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; 3Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou, Taiwan; 4The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of ChinaCorrespondence: Wen I Liu, School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-Te Road, Peitou District, Taipei City, 112303, Taiwan, Tel +886-2-28227101 ext. 3184, Fax +886-2-28213233, Email [email protected] Shih Kai Lee, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, No. 161, Yu-Pin Road, Tsaotun Township, Nan-Tou, 54249, Taiwan, Tel +886-49-2550800 ext. 2100, Email [email protected]: 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.Keywords: medication adherence, insight, medication attitude, mediating effect, schizophrenia, therapeutic alliance, nursing
