Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Search Methods for Identification of Studies
2.3. Eligibility Criteria
2.4. Data Analysis
2.5. Quality Appraisal
3. Results
3.1. Quality Appraisal
3.2. Sample Population
3.3. Treatment Settings and Initiation
3.4. Intervention Approaches
3.5. Control Conditions
3.6. Treatment Completion and Retention
3.7. Primary and Secondary Outcomes
3.8. Measurement of Medication or Treatment Adherence
3.9. Effectiveness of Medication Adherence Interventions
4. Discussion
4.1. Implications for Future Research and Nursing Practice
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Authors Year | Aim | Design | Sample | Setting | Theory-Based | Intervention for Experimental Group | Regular Nursing Care for Control Group | Measurement | Findings | Quality Score |
---|---|---|---|---|---|---|---|---|---|---|
1. Koomala et al., 2020 [25] | To Investigate the effect of medication adherence promotion program in patients with Schizophrenia. | Quasi-experiment | 24 patients with schizophrenia | Inpatient | 1. Psychoeducation 2. Family involvement | No. of sessions: 5 (1 session/day) 1. Therapeutic relationship 2. Individual psychoeducation 3. Individual psychoeducation 4. Family psychoeducation 5. Skill practice Duration: 60–90 min/session Initiation: 1 week before discharge | N/A | 1. Medication Adherence Behaviors Scale | - The program was effective in improving medication adherence. - At 2-week follow-up, the experimental group had a significantly different mean score on medication adherence (p < 0.001). - The experimental group had a significantly different mean score of medication adherence from the control group (p < 0.001). | High risk |
2. Suntarowit et al. 2020 [36] | Compare medication adherence behavior before and after receiving a health promotion program and compare the program with a control group. | Quasi-experiment | 68 patients with schizophrenia | Inpatient | 1. Pender’s health promotion theory | No. of sessions: 6 (in 1 week) 1. Identifying patient’s characteristics 2. Identifying prior behavior 3. Identifying medication adherence & non-adherence 4. Problem-solving 5. Intention to medication adherence 6. Follow-up Duration: 60 min/session Initiation: N/A | 1. Routine daily activity 2. Psychoeducation 3. Group therapy | 1. Health Behavior for Medication Adherence Assessment Form | The program was effective in increasing health behavior for medication adherence. Immediately after the program completion and 1-month follow-up, the experimental group had significantly higher mean medication adherence scores than before (p < 0.001). - The experimental group had a significantly higher mean medication adherence score than the control group (p < 0.001). | High risk |
3. Tanabo-deetumma-jaree & Themrasi, 2018 [37] | To develop and examine the program’s effectiveness to promote illness awareness and belief in taking medication on medication adherence. | Quasi-experiment | 60 patients with schizophrenia | Inpatient | 1. Necessary-concern framework | No. of sessions: 4 (in 2 weeks) 1. Illness awareness promotion 2. Belief in antipsychotic drugs 3. Common concerns and beliefs with antipsychotic drugs 4. Strategies to deal with barriers and individuals that affect medication adherence behavior Duration: 60 min/session Initiation: N/A | 1. Psychoeducation (disease, medication, and self-care) | 1. Brief Illness Perception Questionnaire 2. Beliefs in Taking Medication Questionnaire 3. Self-Medication Intake Record Form | The program was effective in increasing medication adherence behavior. - After program completion, the experiment group had a higher mean score of illness perception than the control group (p < 0.05). - After program completion, the experiment group had a lower belief score in taking medication than the control group (p < 0.05). - At 1,3, 6 months follow-up, the experiment group had a higher average day of medication adherence than the control group (p < 0.05). | High risk |
4. Luangmongkhonchai & Lueboon thavatchai, 2011 [38] | To examine the effects of perceived self-efficacy promotion on medication adherence and follow-up an intention. | Quasi-experiment | 40 patients with schizophrenia | Out-patient | 1. Bandura’s self-efficacy theory | No. of sessions: 5 (in 4 weeks) 1. Emotional & physiological state stimulation 2. Role model 3. Foremost mastery experience 4. Verbal persuasion 5. Previous success experiences and being confident to take medicines and follow-up Duration: 60 min/session Initiation: N/A | 1. Group psychoeducation | 1. Medication Adherence Scale 2. Follow-up Intention Scale | The program effectively increased medication adherence behavior and intention to follow up. - After program completion (week 5), the experimental group had significantly higher mean scores of medication adherence and follow-up intention than that before (p < 0.05). - Experiment group had significantly higher mean scores of medication adherence and follow-up intention than the control group (p < 0.05). | High risk |
5. Phuengnam & Uthis, 2017 [39] | To examine the effect of the family-centered empowerment program on medication adherence. | Quasi-experiment | 40 patients with schizophrenia | Out-patient | 1. Family-centered empowerment model 2. Empowerment 3. Families and family therapy | No. of sessions: 6 (in 4 weeks) 1. Building family’s awareness to medication adherence behavior 2. Developing family’s knowledge and skills 3. Recalling previous experiences on problem-solving 4. Practicing problem-solving skills 5. Exchanging experiences 6. Evaluation Duration: 90 min/session Initiation: N/A | 1. Physical and mental assessment 2. Counseling 3. Advising | 1. Drug Adherence Questionnaire | The program was effective in increasing medication adherence behavior. After program completion, the experimental group had significantly higher mean medication adherence scores than before (p < 0.05). - Experiment group had significantly higher mean scores of medication adherence than the control group (p < 0.05) | High risk |
6. Uthaiphan & Dangdomyouth, 2013 [40] | To examine the effect of group motivational interviewing on medication adherence. | Quasi-experiment | 40 patients with schizophrenia | Out-patient | 1. Motivation interviewing 2. Stage of change | No. of sessions: 5 (in 4 weeks) 1. Behavior change motivation 2. Strengthen commitment to a target behavior change 3. Strengthen commitment to a target behavior change 4. Strengthen commitment to a target behavior change 5. Follow-up Duration: 60–90 min/session Initiation: N/A | 1 Physical and mental assessment 2. Counseling 3. Advising 4. Group psychoeducation | 1. Compliance Behaviors Assessment Scale | The program was effective in increasing medication adherence behavior. After program completion, the experimental group had significantly higher mean medication adherence scores than before (p < 0.05). - Experiment group had significantly higher mean scores of medication adherence than the control group (p < 0.05). | High risk |
7. Wachiradilok & Rungreangkulkit, 2008 [41] | To examine the effect of individual counseling programs on treatment compliance. | Quasi-experiment | 100 patients with schizophrenia | Out-patient | 1. Motivational interviewing 2. Cognitive-behavioral technique | No. of sessions: 5 (1 session/week) 1. Therapeutic relationship 2. Seeking for beliefs and hesitation of treatment 3. Cognitive restructuring 4. Practicing medication administration skills 5. Family’s appropriate emotional expression Duration: 60 min/session Initiation: N/A | N/A | 1. Compliance Behaviors Assessment Scale 2. Knowledge of Self Management Scale 3. Brief Psychotic Rating Scale | The program was effective in increasing treatment adherence behavior and self-management. - At program completion, 3-month, and 6- month follow-up, the experiment group had significantly higher mean scores of compliance behaviors and self-management knowledge than the control group (p < 0.01). | High risk |
8. Eungsanran et al., 2012 [42] | To examine the effect of adherence group therapy program on treatment adherence, drug attitude, psychotic symptoms, and hospital readmission. | Quasi-experiment | 60 patients with schizophrenia | Inpatient | 1. Compliance therapy model 2. Motivational interviewing 3. Cognitive approaches | No. of sessions: 5 1. Engagement 2. Adherence Assessment 3. Eliminating barriers and hesitation on treatment adherence 4. Motivational interviewing and problem-solving 5. Improving self-confidence and practicing medication administration skills Duration: 60 min/session Initiation: N/A | N/A | 1. Medication Adherence Scale 2. Brief Psychotic Rating Scale 3. Drug Attitude Inventory | The program was effective in increasing treatment adherence behavior and positive drug attitude. - At 1-month and 3- month follow-up, the experiment group had significantly higher mean scores of medication adherence (p < 0.05) and drug attitude (p < 0.05), but lower mean scores of psychotic symptoms (p < 0.001) than the control group. - No hospital readmission within three months. | High risk |
9. Maneesakorn et al., 2007 [43] | To evaluate the effectiveness of adherence therapy on psychotic symptoms, general functioning, attitude towards and satisfaction with medication, and medication side effects. | Randomized Controlled Trial | 32 patients with schizophrenia | Inpatient | 1. Compliance therapy 2. Motivational interviewing 3. Cognitive approaches | No. of sessions: 8 (5 phases) (1 session/week) 1. Engagement 2. Assessment: problem, self-confidence, side effects experiences, beliefs, and attitudes 3. Rate readiness to take medicines 4. Intervention: problem-solving, timeline, exploring ambivalence, discussing beliefs and concerns, using medication in the future 5. Evaluation Duration: 15–60 min/session Initiation: N/A | 1. Medication treatment 2. Occupational therapy 3. Group therapy 4. Recreation therapy | Primary: 1. Positive and Negative Syndrome Scale Secondary: 2. Global Assessment of Functioning Scale 3. Drug Attitude Inventory 4. Satisfaction with Antipsychotic Medication Scale 5. Liverpool University Neuroleptic Side Effect Rating Scale | The program effectively increased treatment adherence, attitude toward, and satisfaction with medication. - At nine-week follow-up, the experiment group had significantly more significant improvement on psychotic symptoms (p = 0.001), attitude towards (p = 0.001), and satisfaction with medication (p = 0.019) than the control group. - No significant difference was found in general functioning or side effects. | Moderate risk |
10. von Borman et al., 2015 [44] | To examine the efficacy of adherence therapy on clinical outcomes. | Randomized Controlled Trial | 70 patients with schizophrenia | Inpatient | 1. Compliance therapy 2. Motivational interviewing 3. Cognitive approaches | No. of sessions: 8 sessions (6 exercises) (1 session/week) 1. Assessment: beliefs, problems, medication reconciliation 2. Problem-solving 3. Reviewing previous illness and treatment experiences 4. Seeking ambivalence to take medications 5. Examining beliefs about medication 6. Supporting life goals. Duration: 15–60 min/session Initiation: N/A | 1. Medication, vocational, and recreation therapy 2. Outreach community psychiatric support | Primary: 1. Positive and Negative Syndrome Scale Secondary: 2. Global Assessment of Functioning Scale 3. Drug Attitude Inventory 4. Liverpool University Neuroleptic Side Effect Rating Scale | The program was effective in improving psychotic symptoms - At 26-week follow-up, the experiment group had significantly more significant improvement on psychotic symptoms than the control group (p < 0.05). - No statistically significant differences were found in attitude toward treatment, functioning, or side effects. | High risk |
11. Chaiya-jan et al., 2009 [45] | To examine the effects of a psychoeducation program on attitude toward medication and compliance with a first follow-up appointment. | Quasi-experiment | 55 patients with schizophrenia | Inpatient | 1. Psychoeducation | No. of sessions: 10 sessions (1 session/day for the first six sessions, one session/week for the other four sessions) 1. Therapeutic relationship 2. Illness knowledge 3. Medication knowledge 4. Side effects management 5. Stress management 6. Symptom management 7–10. Assess health conditions, discuss the problem, and problem-solving Duration: -30 min/session (the first 6 sessions)-15–20 min/session (the other 4 sessions) Initiation: Last week of hospital stay | 1. Psychoeducation 2. Reminding of regimens adherence and a follow up visit 3. Home visit | 1. Drug Attitude Inventory | The program was effective in increasing positive attitudes toward medication. - After program completion, the experiment group had a significantly higher positive attitude toward medication (p < 0.05) and proportion of attendance for the first follow-up appointment than the control group (p < 0.05). | High risk |
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Inwanna, S.; Duangchan, C.; Matthews, A.K. Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 2887. https://doi.org/10.3390/ijerph19052887
Inwanna S, Duangchan C, Matthews AK. Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(5):2887. https://doi.org/10.3390/ijerph19052887
Chicago/Turabian StyleInwanna, Suchanart, Cherdsak Duangchan, and Alicia K. Matthews. 2022. "Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 5: 2887. https://doi.org/10.3390/ijerph19052887