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Schizophrenia Bulletin Advance Access originally published online on August 3, 2006
Schizophrenia Bulletin 2006 32(4):786-794; doi:10.1093/schbul/sbl011
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

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

Martijn J. Kikkert1,2, Aart H. Schene2, Maarten W. J. Koeter2, Debbie Robson3, Anja Born4, Hedda Helm4, Michela Nose5, Claudia Goss5, Graham Thornicroft3 and Richard J. Gray3
2 Department of Psychiatry, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
3 Institute of Psychiatry, Kings College, London, UK
4 Department of Psychiatry, Leipzig University, Leipzig, Germany
5 Department of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy

1To whom correspondence should be addressed; tel: +31 (0) 20 5667288, fax: +31 (0) 20 5904441, e-mail: m.j.kikkert{at}amc.uva.nl.

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.

Keywords: medication adherence / schizophrenia / concept mapping


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