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Factors Associated with Medication Adherence among Patients with Schizophrenia in Mekelle, Northern Ethiopia
Open accessAbstract
BACKGROUND: Non-adherence to antipsychotic medication has a negative impact on the course of illness resulting in increased risk of relapse, rehospitalization and suicide, and increased costs to healthcare systems. The objective of this study was to investigate factors associated with medication adherence among patients with schizophrenia at Ayder Referral Hospital and Mekelle Hospital in Mekelle, Tigray region, Northern Ethiopia. METHODS: The study was a cross-sectional survey in which sociodemographic characteristics, drug attitudes, insight and side effects were measured and explored in terms of their relationship with medication adherence. A structured questionnaire as a data collection tool was used. Data were analyzed with the help of SPSS Version 20.0. RESULTS: A total of 393 patients participated, 26.5% were non-adherent to their antipsychotic medication. The factors significantly associated with better adherence were positive treatment attitudes (AOR = 1.40, 95% CI: 1.26, 1.55), fewer side effects (AOR = 0.97, 95% CI: 0.94, 0.99), awareness of illness (AOR = 1.44, 95% CI: 1.12, 1.85) and the ability to relabel symptoms (AOR = 1.57, 95% CI: 1.19, 2.07). However, khat chewers (AOR = 0.24, 95% CI: 0.09, 0.68), being illiterate (AOR = 0.13, 95% CI: 0.03, 0.47) and older age group (AOR = 0.03, 95% CI: 0.01, 0.16) were associated with less medication adherence. CONCLUSIONS: A high prevalence of medication non-adherence was found among patients with schizophrenia. Intervention strategies focused on educating the patients to better understand the illness, medications and their potential side effects might be useful in improving adherence to antipsychotic medication treatment.
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“In six studies, psychiatric patients having lower education level (lower than secondary education) were more likely to be non-adherent to their psychotropic medication compared to those patients having higher educational level [23, 40, 44, 52, 56, 57].”
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 [23]
In the citing paper
“In three studies, patients aged 60 years and older were more likely to be non-adherent to their medication [23, 55, 58].”
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 [23]
In the citing paper
“Patients having negative attitude towards their medication was a factor associated with psychotropic medication non-adherence [23, 25, 39, 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 [23]
In the citing paper
“In three studies, psycho stimulants (e.g., cigarette smoking) was a factor associated with psychotropic medication non-adherence among major psychiatric patients [23, 25, 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 [23]
In the citing paper
“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 [23]
In the citing paper
“In eight studies, both psychostimulant and psycho-depressant substances misuse were associated with psychotropic medication non-adherence [23, 27, 29, 37, 42, 43, 58, 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 [23]
In the citing paper
“In several studies, psychotropic medication non-adherence was associated with medication-related side-effects [11, 22–25, 28–30, 32–37, 39, 44, 50, 52, 55, 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 [23]
In the citing paper
“Likewise, three studies conducted in Ethiopia [23, 25, 65] have reported that “Khat” chewing was a factor associated with psychotropic medication non-adherence among psychiatric 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 [23]
In the citing paper
“In seven studies, patients’ lack of insight (level of awareness or understanding) about their illness and medication was a common factor associated with psychotropic medication non-adherence [21, 23, 28, 39, 40, 50, 51].”
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 [23]
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Citations
Cites
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BackgroundInterventions to Improve Medication Adherence in Schizophrenia
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“The factors consistently associated with non-adherence in patients with schizophrenia are lack of insight, attitudes towards their illness and the medication, past experiences with their illness and its treatment, substance abuse, adverse drug reactions and lack of social support [7,9,10].”
BackgroundInfluentialAntipsychotic Medication Adherence: Is There a Difference Between Typical and Atypical Agents?
Dolder, C. R., Lacro, J. P., Dunn, L. B., & Jeste, D. V. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.103 · Cited by 385 · cited 1×
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Background
Cited by
Sorted by citations
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020) · Systematic Reviews · doi:10.1186/s13643-020-1274-3 · Cited by 555
“, Ethiopia [23] To investigate factors associated with MA among patients with schizophrenia CS Schizophrenia patients Consecutive 393 MARS 97.”
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“35 In a survey of European clinicians, lack of insight into the need for prophylactic medication and lack of insight into illness were the most frequently cited reasons for partial adherence in schizophrenia.”
Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247
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“In previous reports, schizophrenic patients with more previous hospitalizations have been reported to have worse treatment adherence, poorer treatment attitude, easier relapse, and poor support systems [33–35].”
BackgroundShimels, T., Kassu, R. A., Bogale, G., Bekele, M., Getnet, M., Getachew, A., Shewamene, Z., & Abraha, M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0249222 · Cited by 64
“This is in line with other studies that reported that having a comorbid condition [11] and substance use history [11, 47] were associated with high odds of poor medication adherence.”
ResultHUBUNGAN KETERGANTUNGAN SMARTPHONE DENGAN KECEMASAN (NOMOPHOBIA)
Ramaita, R., Armaita, A., & Vandelis, P. (2019) · Jurnal Kesehatan · doi:10.35730/jk.v10i2.399 · Cited by 51
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Parental Factors Associated with Child or Adolescent Medication Adherence: A Systematic Review
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Antipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia
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Comparing cognitive functions in medication adherent and non-adherent patients with schizophrenia
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“5% of patients with schizophrenia were non-adherent to their antipsychotic medication [29] and the result was lower than finding of the study conducted at Bahir Dar Felege Hiwote Referral hospital, northwest Ethiopia which revealed overall prevalence of medication non-adherence was 55.”
ResultEffects of Medication Nonadherence and Comorbidity on Health Resource Utilization in Schizophrenia
Desai, R. A., & Nayak, R. (2018) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2019.25.1.037 · Cited by 43
Factors Affecting Medication Adherence Among Adults with Schizophrenia: A Literature Review
Tham, X. C., Xie, H., Chng, C. M. L., Seah, M.-Y., López, V., & Klainin‐Yobas, P. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.07.007 · Cited by 37
Treatments for people living with schizophrenia in Sub‐Saharan Africa: an adapted realist review
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“A study of 393 schizophrenic patients by Eticha [29] found that 26.”
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“Among outpatient samples in the existing literature, patient-level characteristics, such as age and ethnicity [22], symptom severity [23], and side effects [24], have been correlates of poor adherence to antipsychotic medication, although some of these associations were inconsistent between studies [25].”
ResultAugmented reality for personalized nanomedicines
Lee, Y., & Lee, C. H. (2017) · Biotechnology Advances · doi:10.1016/j.biotechadv.2017.12.008 · Cited by 24
Bahta, M., Ogbaghebriel, A., Russom, M., Tesfamariam, E. H., & Berhe, T. (2021) · Annals of General Psychiatry · doi:10.1186/s12991-021-00348-0 · Cited by 24
Samuel, T., Nigussie, K., Mirkena, Y., & Azale, T. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.980614 · Cited by 28
“Patients who responded “no” for questions 1–6, 9, and 10 and “yes” for questions 7 and 8 were considered compliant (12, 20, 21).”
Matsuda, M., & Kohno, A. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.03.008 · Cited by 30
“In Japan, mental health professionals are keenly aware of the importance of comprehensive community psychiatric treatment based on the bio-psycho-social model and have a strong interest in using psychosocial treatment to improve the quality of life (QOL) of patients who are discharged from hospital.”
BackgroundInfluentialA scoping review: Treatment attitudes and adherence for adults with schizophrenia
Nyanyiwa, S., Peters, K., & Murphy, G. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16219 · Cited by 21
Dou, L., Hu, L., Zhang, N., Cutler, H., Wang, Y., & Li, S. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s255934 · Cited by 21
“Hence, they are often prescribed multiple treatments and pill burden could lead to non-adherence to their medications.(22,42) Furthermore, older patients could fail to adhere to treatments because of cognitive deficit,(43) including working memory loss and impaired executive performance.”
BackgroundResultIbrahim, W, A., Pindar, K, S., Yerima, M, M., Rabbebe, B, I., Shehu, S, et al. (2015) · Journal of Neuroscience and Behavioral Health · doi:10.5897/jnbh2015.0128 · Cited by 20
“These medication-related factors include dosing regimen, side effect profiles, fear of addiction potentials, and concerns about drug-drug interactions (Weiden and Miller, 2001; DiBonaventura et al., 2012; Higashi et al., 2013; Caldeira et al., 2014; Eticha et al., 2015).”
BackgroundGender differences in attitudes towards antipsychotic medications in patients with schizophrenia
Zhou, J., Xiang, Y., Li, Q., Zhu, X., Li, W., Ungvari, G. S., Ng, C. H., Öngür, D., & Wang, X. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.08.041 · Cited by 19
“Attitudes towards antipsychotic medications (i.e., first- and second- generation antipsychotics; FGA and SGA) have been proved to be an important predictor of treatment adherence in schizophrenia patients (Eticha et al., 2015; Sendt et al., 2015).”
BackgroundHabit Strength and Adherence to Oral Contraceptives: the Role of Time- and Place-Based Cues
Murphy, J., Eustace, N., Sarma, K. M., & Molloy, G. J. (2018) · International Journal of Behavioral Medicine · doi:10.1007/s12529-018-9729-9 · Cited by 19
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Hsieh, W. L., Lee, S. K., Chien, W. T., Liu, W., Lai, C. Y., & Liu, C. (2019) · Patient Preference and Adherence · doi:10.2147/ppa.s218553 · Cited by 18
Psychosocial correlates of medication adherence in patients with depressive illness
Prakash, J., Yadav, Y. K., Srivastava, K., & Madhusudan, T. (2019) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_78_19 · Cited by 12
“[4] Very consistently noted that patient-centered psychological risk factors for medication nonadherence are lack of insight, refusal of having an illness, and poor attitude for the given medication.[5] Negative bias toward medication and absence of a belief that a medication will avert the relapse have been found as…”
BackgroundNuño, L., Barrios, M., Moller, M. D., Calderón, C., Rojo, E., Gómez‐Benito, J., & Guilera, G. (2019) · International Journal of Mental Health Nursing · doi:10.1111/inm.12586 · Cited by 12
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“…in IDSs’ motivation for treatment may be overcome by psychosocial approaches such as ACT and MI. 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).”
Zeleke, T. K., Birhane, W., Gubae, K., Kebede, B., & Abebe, R. B. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s422659 · Cited by 11
Tamene, F. B., Mihiretie, E. A., Mulugeta, A., Kassaye, A., Gubae, K., & Wondm, S. A. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06004-7 · Cited by 16
“Additionally, the inclusion criteria varied, such as including only patients aged 18—65 and those who had been on continuous therapy for at least three months prior to the study [16], which may also have influenced the observed differences.”
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Risk factors for readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi
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“Intentional medication non-adherence is common among psychiatric patients, especially those with schizophrenia (Eticha et al. 2015), which was the most common diagnosis among this cohort.”
BackgroundTadesse, G., Geremew, G. W., Alemayehu, T. T., Getachew, D., Demelash, D., & Fentahun, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-22408-w · Cited by 9
“With respect to the regional states, five studies were conducted in Addis Ababa [46–50], five in Oro-mia [45, 51–54], three in Amhara [25, 55, 56], and two each in Tigray [57, 58] and Harari [28, 59].”
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“AMARS score equal to 3 or above indicates adherence, and non-adherence is defined as scores less than or equal to 2 [18].”
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“, khat and alcohol), the severity of the psychotic symptoms, lack of social support, cognitive impairment, and inadequate therapeutic alliance [4, 16, 17, 19, 20].”
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“[10] Extensive studies have found that poor insight in schizophrenia was associated with poor medication compliance([11-15]) and higher risk of relapse and readmission 17] while good insight was closely correlated with better treatment compliance.”
BackgroundZheng, S., Zhang, H., Zhang, M.-H., Li, X., Chang, K., & Yang, F.-C. (2022) · BMC Psychology · doi:10.1186/s40359-022-00919-0 · Cited by 8
“This is because once they not only understand that the disease causes many problems, but they are also gain deeper insights into drug efficacy, phenomena that consequently promote their adherence to medication as previously reported [22, 30].”
ResultTamene, F. B., Sema, F. D., Mihiretie, E. A., Solomon, T., & Sendekie, A. K. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-074112 · Cited by 7
Dameery, K. A., Valsaraj, B. P., Qutishat, M., Obeidat, A. A., Alkhawaldeh, A., Sabei, S. D. A., Omari, O. A., ALBashtawy, M., & Qadire, M. I. A. (2023) · SAGE Open Nursing · doi:10.1177/23779608231197269 · Cited by 6
Does religiosity in persons with schizophrenia influence medication adherence
Davuluri, T., Grover, S., & Chakrabarti, S. (2021) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_413_20 · Cited by 6
“[22,23] When we look at the prevalence of nonadherence from the mean reported figure of 50% across different studies, the nonadherence rate in the present study is lower.”
Addisu, Z. D., Demsie, D. G., Tafere, C., Siraj, E. A., Yazie, T. S., Yimer, E. G., Alemu, N. G., Milikit, Y. Z., Wabela, B. N., Yismaw, M. B., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-21647-6 · Cited by 11
“Additionally, studies by Tadele Eticha et al. 35 , Schadrack Ntirenganya et al. 36 , Merhawi Bahta et al. 37 , Maigari Yusufu Taru et al. 38 , and Irene A. Kretchy et al. 39 explored factors influencing non-adherence, including the role of caregivers’ psychological distress and the extent of…”
Ding, R., He, P., & Zheng, X. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.914245 · Cited by 5
Taru, M. Y., Bamidele, L. I., Faith, A. O., Philip, T. F., Allagoa, E. L. P., & Izevbokun, O. H. (2022) · Journal of Biosciences and Medicines · doi:10.4236/jbm.2022.109008 · Cited by 6
Description of schizophrenia treatment outcomes in Saudi Arabia: A preliminary pilot investigation
AlDosari, F., Alghossen, S. N., Alburaiki, M., Shilbayeh, S. A. R., Albogami, N., Binsaleh, A. Y., Mazrouei, N. A., AlRasheed, H. A., Aldossary, K. M., & Gammoh, O. (2025) · Journal of International Medical Research · doi:10.1177/03000605251332443 · Cited by 4
“46,47 However, it is crucial to acknowledge that other factors, such as socioeconomic background and medication characteristics, can also significantly influence treatment adherence.”
Antipsychotic medication non-adherence and its determinants among out-patients with schizophrenia
Erohubie, P. O., Oriji, S. O., Olotu, S. O., Agbonile, I. O., Anozie, I. G., Erohubie, O. A., Enebe, A. C., & Onu, J. U. (2024) · Malawi Medical Journal · doi:10.4314/mmj.v36i4.8 · Cited by 4
“This is in tandem with findings from previous studies 20,21,23,29 .”
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Arafat, S. M. Y., Mali, B., & Akter, H. (2018) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2018.05.005 · Cited by 4
Potensi Interaksi Obat pada Pasien Skizofrenia di Salah Satu Rumah Sakit Jiwa di Provinsi Jawa Barat
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Adherence to Pharmacological Treatment Among Patients with Schizophrenia
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NON-ADHERENCE TO TREATMENT AMONG SCHIZOPHRENIC PATIENTS
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“On the contrary, a research finding from Mekelle showed that being older is associated with medication non–adherence [16].”
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“[13] Another study in Bangladesh depicted about 87% of the respondents were non-compliant to medications which can be explained by psychopathology of the disorder itself, poor health literacy, and poor status of psychoeducation.”
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Drug therapy problems in patients with schizophrenia: A cross-sectional study
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“24 In Ethiopia, studies regarding DTPs in patients with schizophrenia are generally insuf fi cient.”
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“Many studies have associated nonadherence with adverse medication effects (Eticha et al., 2015; Hibdye et al., 2015; Mert et al., 2015), and others have identified forgetful-ness regarding dosage or timing as a frequent cause (Endale Gurmu et al., 2014; Moritz et al., 2013; Tesfay et al., 2013).”
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“Semahegn et al in a meta-analytic study reported that 56% patients of schizophrenia were non-adherents.(31,32)”
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Attitude towards adherence to long term therapy
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“(25) In the other study by Lifson conducted in Ethiopia, Ethiopians with HIV/AIDS had high levels of adherence (95%).”
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“Educational status also appeared to be a determining factor in existing literature, four studies found that psychiatric patients with lower levels of education (below secondary education) were more likely to be non-adherent compared to those with higher educational attainment [23-26].”
Analysis of Medication Compliance and Reasons for Patients with Schizophrenia in the Community
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“43,44 When patients fail to recognise their condition as a mental illness, they tend to be inconsistent with their treatment, which exacerbates both their symptoms and overall functioning.”
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“46,53 Unintentional medication nonadherence, often attributable to forgetfulness, is a recognized challenge in psychiatric care.”
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“Studies report that medication non-adherence affects roughly 40–60% of individuals with schizophrenia, with some estimates ranging from 20% up to 85% (Dikeç & Kutlu, 2014; Eticha et al., 2015 ).”
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“47 In addition, employed participants demonstrated the highest levels of medication adherence, whereas students exhibited the lowest adherence.”
Metadata
- Authors
- Eticha, T., Teklu, A., Ali, D., Solomon, G., & Alemayehu, A.
- Affiliations
- Mekelle University (ET)
- Corresponding author
- Eticha, Tadele
- ORCID
- Eticha, Tadele
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-03-27
- Volume
- 10
- Issue
- 3
- Pages
- e0120560
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4376899
- OpenAlex
- W2113276173
- Cited by
- 103
- References
- 31
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 9 · 2023: 9 · 2022: 11 · 2021: 12 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 3 · 2016: 11 · 2015: 2
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- medication adherence, schizophrenia, antipsychotic drugs, treatment attitudes, adverse drug reactions, disease awareness, khat chewing, illiteracy, Mekelle, Ethiopia
- MeSH terms
- Adolescent, Adult, Awareness, Cross-Sectional Studies, Ethiopia, Female, Humans, Male, Middle Aged, Patient Compliance, Prognosis, Surveys and Questionnaires, Risk Factors, Schizophrenia, Antipsychotic Agents, Prevalence, Drug Monitoring, Young Adult
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