Association between attitude towards medication, perceived medication influences and levels non-adherence among patients with chronic psychotic disorders attending psychiatry department at Muhimbili

Abstract

Background: Medication non-adherence is a significant global problem in psychiatric practice. Global rates for non-adherence are reported to range from 47% to 95% (Sendt et al., 2015). Attitude towards antipsychotic medication has been one of the most consistently reported and potentially modifiable risk factor for non-adherence (Kim et al., 2019). Individual patient attitudes and perceived benefit from medication can influence adherence behavior and hence the outcome in patients with chronic psychotic disorders. Despite their significant influence on adherence, little is known about the subject in lower income countries. Aim of the study: The aim of the study is to examine the association between levels of non-adherence and attitude toward medications and perceived medication influences among patients with chronic psychotic disorders. Materials and methods; This was a secondary analysis of phase 1 quantitative data from a 3-phase uncontrolled prospective intervention trial that focused on refinement and preliminary testing of a customized adherence enhancement program combined with long-acting injectable antipsychotic medication for poorly adherent patients with chronic psychotic disorders. One hundred patients with chronic psychotic disorders were recruited during the phase 1 of the project. Participants were assessed for their levels of non-adherence, attitudes towards antipsychotic medication and perceived medication influences. Other potential predictors of non-adherent behavior were measured including clinical and demographic factors. Data was analyzed using SPSS version 23.0 and logistic regression was applied to explain the relationships between the variables. Bivariate association was calculated by using the chi-square test and variables with p<0.2 were taken through multivariate analysis to determine if the said variables were predictive of non-adherent behavior for patients with chronic psychotic disorders. Variables with p<0.05 were considered to be statistically significant.Results: The mean age of the patients was 35.7 years (SD, 8.80). There were 61 (61%) males and 39 (39%) males. The mean self-reported non-adherence level for the past one week was 89.87% and for the past one month was 64.44%. Attitudes towards antipsychotic medication in this sample were rather negative with 51 participants (51%) falling in the more negative attitudes category. Half of the sample (50%) also had more negative perceived medication influences. Gender was significantly associated with levels of non-adherence for past one week and past month (p=0.015, p=0.002) and male participants were three times more likely to be non-adherent as compared to females in past one week (p=0.022; AOR=3.751; 95% CI 1.21 – 11.63) and four times more likely to be non-adherent in the past month (p=0.002; AOR= 4.809; 95% CI 1.74 – 13.29). Perceived medication influences was significantly associated with levels of non-adherence in the past one month (p=0.027) in the bivariate analysis and marginally associated with non-adherence in the multivariate analysis. Attitude towards antipsychotic medication however showed no significant association with levels of non-adherence for both the past one week and past one month. Conclusion: Non-adherence to antipsychotic medication has been shown to be an important barrier to the successful treatment of persons with chronic psychotic disorders and is a frequent cause of exacerbations in psychopathology, psychotic relapse and re-hospitalization. It is recommended that further research using larger samples are conducted in our settings to understand modifiable risk factors for non-adherence in patients with chronic psychotic disorders and design appropriate interventions to address these modifiable factors.