Perspectives on reasons for non-adherence to medication in persons with schizophrenia in Ethiopia: a qualitative study of patients, caregivers and health workers
Open accessAbstract
BACKGROUND: Levels of non-adherence to antipsychotic medication in persons with schizophrenia in rural African settings have been shown to be comparable to those found in high-income countries. Improved understanding of the underlying reasons will help to inform intervention strategies relevant to the context. METHODS: A qualitative study was conducted among persons with schizophrenia (n = 24), their caregivers (n = 19), research field workers (n = 7) and health workers (n = 1) involved in the ongoing population-based cohort study, 'The Butajira Study on Course and Outcome of Schizophrenia and Bipolar Disorder', based in rural Ethiopia. Six focus group discussions and 9 in-depth interviews were conducted to elicit perspectives on non-adherence to antipsychotic medication. Thematic analysis was used to identify prominent perspectives. RESULTS: Predominant reasons for non-adherence specific to a low-income country setting included inadequate availability of food to counter appetite stimulation and the perceived strength of antipsychotic medications. The vital role of the family or other social support in the absence of a statutory social safety net was emphasised. Expectations of cure, rather than need for continuing care, were reported to contribute to non-adherence in the longer-term. Many of the factors associated with non-adherence in high-income countries were also considered important in Ethiopia, including lack of insight, failure to improve with treatment, medication side effects, substance abuse, stigma and dissatisfaction with the attitude of the care provider. CONCLUSION: This study identifies additional barriers to medication adherence faced by persons with schizophrenia in Ethiopia compared to those in high-income countries. In this era of scaling up of mental health care, greater attention to provision of social and financial assistance will potentially improve adherence and thereby enable patients to benefit more fully from medication.
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Having a history of concurrent alcohol dependency was the main factor associated with psychotropic medication non-adherence in six studies.
“In addition, in six studies, having a history of concurrent alcohol dependency was the main factor associated with psychotropic medication non-adherence [23, 25, 37, 47, 64, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Psychiatric patients may attribute antipsychotic medication non-adherence to alterations in cognitive and attitudinal functioning and therefore be unwilling to use the medication in three studies.
“In three studies, psychiatric patients may also attribute to antipsychotic medication non-adherence due to the alterations in cognitive and attitudinal functioning and therefore be unwilling to use the medication [29, 37, 38].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Long treatment duration (6-12 months and longer) was an associated factor for medication non-adherence in five studies.
“In five studies, long treatment duration (6–12 months and longer) was an associated factor for medication non-adherence [22, 25, 37, 43, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Misunderstanding about treatment consequences, lack of awareness of their illness and/or mental disorder in general, and sometimes appreciating subjective relief symptoms were factors associated with medication non-adherence among major psychiatric disorder patients.
“Likewise, misunderstanding about the treatment consequences, lack of awareness of their illness and or mental disorder in general, and sometimes appreciating subjective relief symptoms [30, 36, 37] were the factors associated with medication non-adherence among major psychiatric disorder patients.”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Sleepiness during day time (medication dose time) and potentially life-threatening or distressing side-effects seriously affected patients' medication non-adherence in two studies.
“In two studies, sleepiness during day time (medication dose time) and potentially life-threatening or distressing side-effects seriously affected patients’ medication non-adherence [37, 44].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Feeling of powerlessness, insomnia, difficulty thinking or concentrating, restlessness, or feeling jittery were found to be associated with medication non-adherence in two studies.
“Another two studies, feeling of powerlessness, insomnia, difficulty thinking or concentrating, restlessness, or feeling jittery were found to be associated with medication non-adherence [28, 37].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Health care providers' negative attitude influenced patients' adherence to the medication and their follow-ups in one study.
“In one study, health care providers’ negative attitude had influenced patients’ adherence to the medication and their follow-ups [37].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Limited or inadequate patient information, weak professional or family support, therapeutic alliance, social involvement, and low education were social support-related factors in two studies.
“In two studies, limited or inadequate patient information, weak professional or family support, therapeutic alliance, social involvement, and low education were some of the social support-related factors [36, 37].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
Various social support-related factors (cohesiveness, family reminding, transport to hospital, lower family harmony, discrimination, disruption of family functioning, weak community functioning, homelessness, old age caregivers, lack of family compliance, lack of advice, not receiving social assistance, caregivers' attribution) were associated with psychotropic medication non-adherence.
“Cohesiveness, family reminding, and transport to hospital [37], lower family harmony or lack of resilient family support, discrimination by nearby people, disruption of family functioning or household routine and religious practices [45], weak community functioning [39], homelessness [42, 43], had old age caregivers or lack of caregivers [50], lack of family compliance of follow-up [51], lack of”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [37]
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Flagged first, then by citations
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Mall, S., Hailemariam, M., Selamu, M., Fekadu, A., Lund, C., Patel, V., Petersen, I., & Hanlon, C. (2016) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015001006 · Cited by 85 · see citing works
“This resonates with a previous qualitative study from rural Ethiopia in which people with SMDs and their caregivers spoke of the difficulties adhering to psychotropic medication and attending follow-up appointments due to food insufficiency and poverty (Teferra et al. 2013).”
ResultSelf-citationMayston, R., Alem, A., Habtamu, A., Shibre, T., Fekadu, A., & Hanlon, C. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv072 · Cited by 77 · see citing works
“Modern psychiatric treatment of SMD is unusual in rural Ethiopia, but free consultation, medication and follow-up were offered as benefits to participants in the cohort study (Teferra et al. 2013).”
BackgroundSelf-citationAbdisa, E., Fekadu, G., Girma, S., Shibiru, T., Tilahun, T., Mohamed, H., Wakgari, A., Takele, A., Abebe, M., & Tsegaye, R. (2020) · International Journal of Mental Health Systems · doi:10.1186/s13033-020-00391-6 · Cited by 71 · see citing works
“This leads to increased hospitalization, higher healthcare costs and is a predictor of poor outcomes like more relapses, suicide and overall mortality [30, 31].”
BackgroundBrain, C., Kymes, S. M., DiBenedetti, D. B., Brevig, T., & Velligan, D. I. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1833-5 · Cited by 70 · see citing works
Wade, M., Tai, S., Awenat, Y. F., & Haddock, G. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.10.009 · Cited by 69 · see citing works
“Furthermore, they believed that others would interpret medication use as a sign of schizophrenia (Rogers et al., 1998) and thus discontinued to prevent others from discovering their illness (Teferra et al., 2013).”
BackgroundMethodResultInfluentialInvolvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study
Souraya, S., Hanlon, C., & Asher, L. (2018) · Globalization and Health · doi:10.1186/s12992-018-0403-4 · Cited by 68 · see citing works
Self-citationTsigebrhan, R., Shibre, T., Medhin, G., Fekadu, A., & Hanlon, C. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.10.032 · Cited by 66 · see citing works
“Although people with SMI in our study did not have to pay for antipsychotic medication, the inaccessibility of centralized psychiatric services and influence of poverty meant that non-adherence was commonplace and likely to be associated with poorly controlled symptoms (Teferra et al., 2013).”
Self-citationGrover, S., Singh, A., & Mattoo, S. (2016) · Indian Journal of Social Psychiatry · doi:10.4103/0971-9962.181095 · Cited by 58 · see citing works
Thompson, J., Stansfeld, J. L., Cooper, R. E., Morant, N. J., Crellin, N. E., & Moncrieff, J. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01819-2 · Cited by 58 · see citing works
Tirfessa, K., Lund, C., Medhin, G., Hailemichael, Y., Fekadu, A., & Hanlon, C. (2017) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796017000701 · Cited by 53 · see citing works
“It is possible that they reported higher food insecurity levels than other household members due to less access to household resources than other household members or that they experienced greater hunger due to appetite-stimulating effects of antipsychotic medication (Teferra et al. 2013); however, only a third (35.”
BackgroundSelf-citationIncidence and factors associated with medication nonadherence in patients with mental illness
Lucca, J., Ramesh, M., Parthasarathi, G., & Ram, D. (2015) · Journal of Postgraduate Medicine · doi:10.4103/0022-3859.166514 · Cited by 51 · see citing works
“This was linked to other studies [3,18-20] Other diagnoses include: schizoaffective disorders (10), delusional disorders (10), somatoform disorders (13), conversion disorders (8), Dhat syndrome (6), acute stress disorder (6), dissociative disorder (6), personality disorders (2) and sleep disorders…”
Demeke, S. M., Mossie, T. B., Mekonen, T., & Menberu, M. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00464-0 · Cited by 51 · see citing works
“Non-adherence could result from psychotropic medication side effects [51]; a study from Butajira, Ethiopia also stated that side effects of medications as a reason for non-adherence [52].”
BackgroundKirchner, S.-K., Lauseker, M., Adorjan, K., Anderson‐Schmidt, H., Anghelescu, I., Baune, B. T., Budde, M., Dannlowski, U., Dietrich, D. E., Fallgatter, A. J., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.713060 · Cited by 50 · see citing works
Adolescents’ and Young Adults’ Beliefs about Mental Health Services and Care: A Systematic Review
Goodwin, J., Savage, E., & Horgan, A. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.04.004 · Cited by 43 · see citing works
“Stigma surrounding medication/mental illness can result in non-adherence (Teferra et al., 2013), and non-adherence with medication is associated with high relapse rates (Haddad et al., 2014).”
BackgroundAntipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia
Tareke, M., Tesfaye, S., Amare, D., Mossie, T. B., & Abate, A. (2018) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v24i0.1124 · Cited by 44 · see citing works
Habtamu, K., Alem, A., Medhin, G., Fekadu, A., & Hanlon, C. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1546-6 · Cited by 43 · see citing works
Self-citationBrain, C., Sameby, B., Allerby, K., Quinlan, P. S., Joas, E., Lindström, E., Burns, T., & Wærn, M. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.10.016 · Cited by 40 · see citing works
“to adherence in a recent qualitative study (Teferra et al., 2013).”
BackgroundShibre, T., Medhin, G., Alem, A., Kebede, D., Teferra, S., Jacobsson, L. H., Kullgren, G., Hanlon, C., & Fekadu, A. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.10.053 · Cited by 37 · see citing works
“In an earlier medication non-adherence study from the same population, factors such as poverty and family support were the most important reasons for non-compliance compared to tolerability indicating that there aremore salient factors thatmight need further study (Teferra et al., 2013).”
BackgroundSelf-citationTownsend, M., Pareja, K., Buchanan-Hughes, A., Worthington, E., Pritchett, D., Brubaker, M., Houle, C., Mose, T. N., & Waters, H. (2022) · Patient Preference and Adherence · doi:10.2147/ppa.s343211 · Cited by 39 · see citing works
“One, for example, told us not to talk to him in public and has stopped the medication just because he didn’t want others to know that he is mentally ill.(57,79)” One study also found that some long-term hospital patients felt that being in a hospital provided a supportive social network, reduced their sense of stigma…”
BackgroundKeogh, B., Murphy, E., Doyle, L., Sheaf, G., Watts, M., & Higgins, A. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1922644 · Cited by 34 · see citing works
“Findings Findings from the systematic searches In total fourteen (n1⁄4 14) articles (Bjornestad et al., 2017; Boath et al., 2004; B€ ulow et al., 2016; Cappleman et al., 2015; Fu et al., 2019; Gale et al., 2012; Givens et al., 2006; Katz et al., 2019; Le Geyt et al., 2017; Roe et al., 2009; Salomon & Hamilton, 2013; T…”
BackgroundInfluentialSalzmann‐Erikson, M., & Sjödin, M. (2018) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2018.05.003 · Cited by 33 · see citing works
Gamieldien, F., Galvaan, R., MYERS, B. J., & Sorsdahl, K. R. (2021) · Community Mental Health Journal · doi:10.1007/s10597-021-00904-8 · Cited by 33 · see citing works
“, 2011), poverty and food insecurity (Jenkins et al., 2010; Teferra et al., 2013), stigma and discrimination (Egbe et al.”
BackgroundLambert‐Kerzner, A., Ho, P. M., Havranek, E. P., Plomondon, M. E., Fagan, K., McCreight, M. S., Fehling, K. B., Albright, K., Hamilton, A., DelGiacco, E., et al. (2015) · Patient Preference and Adherence · doi:10.2147/ppa.s84546 · Cited by 31 · see citing works
Khat use in people living with HIV: a facility-based cross-sectional survey from South West Ethiopia
Soboka, M., Tesfaye, M., Feyissa, G. T., & Hanlon, C. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0446-5 · Cited by 28 · see citing works
“A qualitative study carried out in Ethiopia among people with schizophrenia found that many respondents were fearful that khat might interact with their medication, leading patients to choose one or the other [35].”
BackgroundSelf-citationTownsend, M., Pareja, K., Buchanan-Hughes, A., Worthington, E., Pritchett, D., Brubaker, M., Houle, C. R., Mose, T. N., & Waters, H. C. (2022) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 27 · see citing works
Ezeala-Adikaibe, B., Mbadiwe, N., Okudo, G., Nwosu, N., Nwobodo, N., Onyebueke, G., Nwobodo, M., Nnaji, T., Okafor, U. H., Orjioke, C., et al. (2017) · Archives of Community Medicine and Public Health · doi:10.17352/2455-5479.000021 · Cited by 27 · see citing works
“Studies suggest that adherence does not seem to correlate with the number of drugs prescribed but the number of dosing times every day of all prescribed medications [2-4,8-12].”
Background(2024) · doi:10.1186/s12888-024-05554-0 · Cited by 25 · see citing works
“Poor insight can range from absolute denial of illness and rejection of the precise diagnosis to symptom, mitigation and explanations, as well as a failure to recognize that medications are required to treat specific symptoms and lower the risk of relapse [22].”
BackgroundReasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort
Ahmad, I., Khalily, M. T., & Hallahan, B. P. (2017) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.07.024 · Cited by 25 · see citing works
Watts, M., Murphy, E., Keogh, B., Downes, C., Doyle, L., & Higgins, A. (2021) · International Journal of Mental Health Nursing · doi:10.1111/inm.12894 · Cited by 24 · see citing works
Adesão do portador de transtorno mental à terapêutica medicamentosa no tratamento em saúde mental
Borba, L. D. O., Maftum, M. A., Vayego, S. A., Mantovani, M. D. F., Félix, J. V. C., & Kalinke, L. P. (2018) · Revista da Escola de Enfermagem da USP · doi:10.1590/s1980-220x2017006603341 · Cited by 23 · see citing works
“In this sense, the long period of treatment and the continuous use of medications are identified as factors that hinder adherence to medication use(25-26).”
BackgroundGudeta, D. B., Leta, K., Alemu, B., & Kandula, U. R. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283829 · Cited by 21 · see citing works
“It is not consistent with the findings of study which found patients feeling better [4] and expectation of cure rather than continuing treatment leads for treatment non adherence [17].”
ResultBitew, B. D. (2014) · American Journal of Health Research · doi:10.11648/j.ajhr.20140205.13 · Cited by 21 · see citing works
Implementation of medicines pricing policies in sub-Saharan Africa: systematic review
Koduah, A., Baatiema, L., de Chavez, A. C., Danso‐Appiah, A., Kretchy, I. A., Agyepong, I. A., King, N. V., Ensor, T., & Mirzoev, T. N. (2022) · Systematic Reviews · doi:10.1186/s13643-022-02114-z · Cited by 20 · see citing works
“Studies were excluded based on wrong outcome (n=57), population (n=5), not SSA (n=2), study type (n=28), publication type (n=4), background article (4) or duplicate (2) and these are detailed in the PRISMA ow diagram (Figure 1).”
BackgroundWoldehaimanot, T. E., Wubishet, B. L., Teklay, G., Shewamene, Z., Abera, M., Workneh, B. D., & Demoz, Z. (2014) · Patient Preference and Adherence · doi:10.2147/ppa.s69702 · Cited by 20 · see citing works
“Improved understanding of the magnitude and underlying reasons for non-adherence would help to design contextually modified strategies.(12) This study was conducted to assess levels of adherence and its determinants in patients attending a psychiatric clinic in Ethiopia.”
BackgroundZewdu, W. S., Dagnew, S. B., Tarekegn, G. Y., Yazie, T. S., Ayicheh, M. A., Dagnew, F. N., & Moges, T. A. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06838-9 · Cited by 18 · see citing works
“Except for the study by Teferra et al. [48], which was a qualitative cohort study, all other studies were hospital-based cross-sectional quantitative in nature.”
The meaning of pharmacological treatment for schizophrenic patients
Vedana, K. G. G., & Miasso, A. I. (2014) · Revista Latino-Americana de Enfermagem · doi:10.1590/0104-1169.3427.2466 · Cited by 18 · see citing works
“Studies indicate that positive results of drug treatment can favor adherence(13) but, when associated with an expected cure, they can arouse questions about the need to maintain the treatment(22).”
BackgroundAprile, S. F., Rodolico, A., Francesco, A. D., Varrasi, S., Bighelli, I., Castellano, S., Signorelli, M. S., Leucht, S., & Caraci, F. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116460 · Cited by 16 · see citing works
“The results highlight that beyond specific issues such as concentration difficulties (Windgassen, 1992) and drowsiness (Teferra et al., 2013), patients reported a broader impact: antipsychotic medications hindered their ability to engage in social activities and perform daily tasks (Novak and Svab,…”
Belayneh, Z., Angaw, D. A., Amare, T., Haile, K., & Zegeye, A. (2019) · BMC Public Health · doi:10.1186/s12889-019-6678-4 · Cited by 13 · see citing works
Access and rational use of psychotropic medications in low- and middle-income countries
Padmanathan, P., & Rai, D. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015000803 · Cited by 12 · see citing works
“…include stigma associated with mental illness and its treatment, difficulty in travelling to a place where medications are accessible, the financial burden associated with buying medications, medication side effects and lack of perceived effectiveness (Pareek & Kalia, 2013; Teferra et al. 2013).”
BackgroundAshong, S., Kretchy, I. A., Afrane, B. A., & Aikins, A. D. (2018) · Psychiatry Journal · doi:10.1155/2018/9850594 · Cited by 12 · see citing works
“Numerous factors have been determined to affect patient adherence including poor medication efficacy [21, 22], adverse drug reactions [21, 23], unavailability of medications [24, 25], preference for complementary and alternative medicine [26, 27], spirituality [28], personality traits of patients [29], distance of hos…”
BackgroundYıldız, E., & Aylaz, R. (2020) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390320945380 · Cited by 13 · see citing works
“Noncompliance with treatment due to a lack of motivation in IDSs is a common finding in many studies (Eticha et al., 2015; Salzmann-Erikson & Sjödin, 2018; Teferra et al., 2013; Wade et al., 2017).”
ResultZeleke, T. K., Birhane, W., Gubae, K., Kebede, B., & Abebe, R. B. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s422659 · Cited by 11 · see citing works
Medication non-adherence and its influencing factors in persons with schizophrenia in rural China
Li, X., Deng, S.-Y., Zhang, T., Wang, Y., Wong, I. Y.-L., & Ran, M. (2022) · Journal of Mental Health · doi:10.1080/09638237.2022.2140789 · Cited by 11 · see citing works
“Of note, there is an absence of a gold standard or common measurement to evaluate the medication adherence, the reports from family caregivers and mental health professionals are also viewed as crucial evidence (Adewuya et al., 2009; Teferra et al., 2013).”
BackgroundIdris, A., Akhir, N. M., Mohamad, M. S., & Sarnon, N. (2023) · Behavioral Sciences · doi:10.3390/bs13020151 · Cited by 9 · see citing works
“In addition, social stigma may then lead to self-stigma, increased suicide attempts, relapses, and overall mortality [39].”
BackgroundMihalo, J. R., Warnecke, A. J., Baum, C. A., & Goreczny, A. J. (2015) · International Journal of Mental Health · doi:10.1080/00207411.2015.1035065 · Cited by 8 · see citing works
“The Butajira Study on Course and Outcome of Schizophrenia and Bipolar Disorder found that stigma is one factor contributing to medication nonadherence in Ethiopia as well as in high-income countries such as the United States [13].”
BackgroundFavina, A., Hobe, N., Muwanguzi, M., Munaru, G., Rubega, A., Lutasingwa, D., Kirabira, J., Rukundo, G. Z., & Ashaba, S. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000132 · Cited by 7 · see citing works
“The consequences of affiliate stigma therefore affect both the caregiver and the person with mental illness, with a negative impact on the overall treatment outcomes [43,44].”
Issac, A., Nayak, S. G., George, R., Priyadarshini, T., & Jacob, J. (2025) · Nursing and Health Sciences · doi:10.1111/nhs.70153 · Cited by 7 · see citing works
“Poverty significantly impacts medication adherence in these regions (Meshach O et al. 2014; Teferra et al. 2013).”
Zhou, H., Ma, F., Zhang, Y., Tan, Y., Bai, Y., Hu, Q., Wei, W., & Wang, Y. (2022) · Patient Preference and Adherence · doi:10.2147/ppa.s372487 · Cited by 7 · see citing works
“For some patients, they think the side effects of antipsychotic drugs intolerable, resulting in discontinuation of antipsychotic drugs and low treatment adherence, which is detrimental for patients’ health.(14) Hence, how the side effects of antipsychotics are considered and handled affects the treatment and prognosis…”
BackgroundMay, C. R., Gravenhorst, K. C., Hillis, A., Arber, M. R., Chew-Graham, C. A., Gallacher, K., Mair, F. S., Nolte, E., & Richardson, A. M. (2024) · Health and Social Care Delivery Research · doi:10.3310/hgtq8159 · Cited by 8 · see citing works
So, Y. K., Chan, C. Y., Fung, S. C., Lui, T. T., Lau, F. C., Chan, S. K. W., Lee, E. H. M., Lui, S. S. Y., Hui, C. L. M., Chen, E. Y. H., et al. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02563-4 · Cited by 6 · see citing works
“Previous Previous qualitative studies further revealed that schizophrenia patients may consider taking medications as a signal of “psy-chiatric patient” status, and opted to discontinue medications as a way to conceal their illness from others [57, 58].”
A Review of Factors Relating to Medication Non-Adherence in Patients with Schizophrenia
Meepring, S., Tulyakul, P., Sathagathonthun, G., & Suppasri, J. (2021) · Global Journal of Health Science · doi:10.5539/gjhs.v13n10p52 · Cited by 6 · see citing works
“In the meantime, patients’ caregivers skipped medication if they saw that their patients were drunk (Teferra et al., 2013).”
InfluentialNecyk, C., Khamba, B., Chue, P. S., Urichuk, L., Snaterse, M., & Vohra, S. (2016) · Current Medical Research and Opinion · doi:10.1185/03007995.2016.1174109 · Cited by 6 · see citing works
Medication non-adherence in re-admitted patients at a psychiatry hospital: A qualitative study
Zwide, G. E., Dewet, Z. T., & Sokudela, F. B. (2025) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v31i0.2345 · Cited by 5 · see citing works
“10,14,16,18,42 Side effects from medication may affect patients’ quality of life and thus perpetuate a further barrier to adherence.”
Favina, A., Munaru, G., Muwanguzi, M., Rubega, A., Lutasingwa, D., Maling, S., & Ashaba, S. (2024) · BMC Psychology · doi:10.1186/s40359-024-01947-8 · Cited by 5 · see citing works
“However, when caregivers experience affiliate stigma, the coordination with mental health providers and provision of care for individuals with mental illness is affected, impairing the adherence to treatment and treatment outcomes of the patients [14–16].”
BackgroundAlkholy, R., Lovell, K., Bee, P., Pedley, R., Brooks, H. L., Drake, R., Chitsabesan, P., Bhutta, A., Brown, A., Jenkins, R., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0308037 · Cited by 4 · see citing works
USO DE PSICOFÁRMACOS PELO PORTADOR DE TRANSTORNO MENTAL: PERCEPÇÕES DO ENFERMEIRO
Czarnobay, J., Brusamarello, T., Capistrano, F. C., Marín, M. J. S., Nimtz, M. A., & Maftum, M. A. (2018) · Cogitare Enfermagem · doi:10.5380/ce.v23i1.52149 · Cited by 4 · see citing works
“Estudos apontam que resultados positivos do tratamento farmacológico podem favorecer a adesão, mas, quando associados à expectativa de cura, podem suscitar o questionamento sobre a necessidade de manutenção do tratamento(19-20).”
BackgroundVentura, C. A. A., Carrara, B. S., da Silva, F. P., Vedana, K. G. G., dos Reis, L. N., Vidigal, B. A. A., & de Moura, A. L. M. (2023) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2022.12.024 · Cited by 4 · see citing works
Mgweba-Bewana, L., Belus, J. M., Ipser, J., Magidson, J. F., & Joska, J. A. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114127 · Cited by 4 · see citing works
Gebru, W. A., Kidanemariam, G., Berhe, K. T., Begashaw, T. D., Reta, H. G., & Gebreslassie, H. T. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07202-7 · Cited by 3 · see citing works
“Thus, non-adherence remains a challenge for patients with psychiatric disorders and their health care providers, contributing to a substantial worsening of the disease, frequent relapse, increased mortality, re-hospitalization, and increased health care costs [47].”
Sánchez, C. R. L. (2015) · Science Journal of Public Health · doi:10.11648/j.sjph.20150302.15 · Cited by 3 · see citing works
“A study of schizophrenic patient concluded patients did not want to be seen taking medications for mental health disorders, which led to non-adherence to medication [24].”
BackgroundBlessing, E., Sunday, O. O., Omoaregba, J. O., & Bawo, O. J. (2020) · International Neuropsychiatric Disease Journal · doi:10.9734/indj/2020/v14i430138 · Cited by 3 · see citing works
Mamo, E. S., & Gelaw, B. K. (2016) · Advances in Pharmacoepidemiology & Drug Safety · doi:10.4172/2167-1052.1000200 · Cited by 3 · see citing works
“Second, disorganization and cognitive impairment are additional symptoms of schizophrenia that interfere with medication management [12].”
BackgroundNON-ADHERENCE TO TREATMENT AMONG SCHIZOPHRENIC PATIENTS
Manhas, R. S., Manhas, A., Akhter, R., Thappa, J. R., & Manhas, G. S. (2019) · International Journal of Medical and Biomedical Studies · doi:10.32553/ijmbs.v3i10.595 · Cited by 3 · see citing works
Teferra, S. (2020) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v26i0.1418 · Cited by 3 · see citing works
Self-citationBenelmokhtar, J. M., Chiliza, B., Phahladira, L. S., Emsley, R. A., & Asmal, L. (2021) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v27i0.1657 · Cited by 3 · see citing works
A Family-Based Intervention for People with a Psychotic Disorder in Nicaragua
van der Geest, R. (2017) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-39510-8_25 · Cited by 3 · see citing works
Adane, A., Zerihun, D., Warkaw, A., Misganaw, S., & Mulualem, S. (2024) · Research Square · doi:10.21203/rs.3.rs-3909394/v1 · Cited by 3 · see citing works
Beyene, M. G., Teferra, S., & Fenta, T. G. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314403 · Cited by 2 · see citing works
Self-citationFactors Associated with Relapse of Schizophrenia in Bangladesh
Hassan, M. K., Islam, M. I., Kamal, A. H. M. K. M., & Alam, M. J. (2020) · American Journal of Psychiatry and Neuroscience · doi:10.11648/j.ajpn.20200803.14 · Cited by 2 · see citing works
“[21-23] The distribution of expressed emotion in the family of the relapsed schizophrenic patients revealed about 52% had high expressed emotion and 48% had low expressed emotion.”
BackgroundImplementation of Medicines Pricing Policies In Sub-Saharan Africa: Systematic ReviewPreprint
Koduah, A., Baatiema, L., de Chavez, A. C., Danso‐Appiah, A., Kretchy, I. A., Agyepong, I. A., King, N. V., Ensor, T., & Mirzoev, T. N. (2021) · Research Square · doi:10.21203/rs.3.rs-1107173/v1 · Cited by 2 · see citing works
Alalbila, T. M., Wiafe, E., Alhassan, S. M., Yamoah, P., Dordoye, E. K., Nyoagbe, J. K. N., Hutton-Nyameaye, A., Sefah, I. A., Jones, J., Awuttey, H., et al. (2024) · Scientific African · doi:10.1016/j.sciaf.2024.e02436 · Cited by 1 · see citing works
Read, U. M., Siddiqi, B. A., Aminu, K., Afolayan, A., Haque, M. T., Khan, A., Alam, N. B., Iyer, S. N., Jegede, C. O., Omigbodun, A. O., et al. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100575 · Cited by 1 · see citing works
Hulagi, N. M., Nanjegowda, R. B., Noorthoorn, E. O., Palmstierna, T., & Lepping, P. (2026) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry_728_24 · Cited by 1 · see citing works
“[2] If a person is found to be non-adherent to medicine, a mental health professional may consider several interventions, including physical restraint, [3] chemical restraintsm, [4] or concealing medications in food or drink without the patient’s knowledge or agreement [5] —a practice known as…”
Daliri, D. B., Laari, T. T., Abagye, N., & Afaya, A. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-079933 · Cited by 1 · see citing works
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- Authors
- Teferra, S., Hanlon, C., Beyero, T., Jacobsson, L., & Shibre, T.
- Affiliations
- Addis Ababa University (ET)
- King's College London (GB)
- Umeå University (SE)
- Corresponding author
- Teferra, Solomon
- ORCID
- Hanlon, Charlotte
- Venue
- BMC Psychiatry
- Published
- 2013-06-17
- Volume
- 13
- Issue
- 1
- Pages
- 168-168
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3686587
- OpenAlex
- W2103579594
- Cited by
- 97
- References
- 57
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 7 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 7 · 2019: 3 · 2018: 11 · 2017: 8 · 2016: 8 · 2015: 9 · 2014: 5 · 2013: 1
- FWCI
- 6.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Styrelsen för Internationellt Utvecklingssamarbete
- Stanley Medical Research Institute
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- medication non-adherence, antipsychotic drugs, schizophrenia, Ethiopia, rural mental health services, food insecurity, appetite stimulation, family social support, social safety nets, treatment expectations, lack of insight, adverse drug reactions, substance abuse, stigma
- MeSH terms
- Adult, Attitude of Health Personnel, Ethiopia, Female, Health Personnel, Humans, Male, Schizophrenia, Schizophrenic Psychology, Social Support, Antipsychotic Agents, Caregivers, Qualitative Research, Medication Adherence, Social Stigma
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