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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
Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n1007 · Cited by 1,383 · cited 1×
“A comprehensive review [3] reported that the rate of medication non-adherence in patients with schizophrenia is as high as 40%–50%.”
BackgroundReliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses
Thompson, K. N., Kulkarni, J., & Sergejew, A. A. (2000) · Schizophrenia Research · doi:10.1016/s0920-9964(99)00130-9 · Cited by 1,055 · cited 1×
“A MARS score equal to 3 or above indicates adherence, and non-adherence is defined as scores less than or equal to 2 [16].”
BackgroundHogan, T. P., Awad, A. G., & Eastwood, R. (1983) · Psychological Medicine · doi:10.1017/s0033291700050182 · Cited by 1,032 · cited 5×
“2% [19]; England, 29% [20]; Hong Kong, 30% [15] and Egypt, 74% [21].”
BackgroundResultInfluentialA self‐report Insight Scale for psychosis: reliability, validity and sensitivity to change
Birchwood, M. J., Smith, J., Drury, V., Healy, J., Macmillan, F., & Slade, M. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01487.x · Cited by 695 · cited 1×
“The score of each subscale ranges from 0 to 4 [14].”
BackgroundHigashi, K., Medić, G., Littlewood, K. J., Díez, T., Granström, O., & Binder, M. D. (2013) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125312474019 · Cited by 626 · cited 4×
“Non-adherence to medication can lead to relapse, which can mean more visits to the emergency room, rehospitalizations and increased need for clinician intervention—all of which lead to increased costs to healthcare systems [7,8].”
BackgroundInfluentialVelligan, D. I., Weiden, P. J., Sajatovic, M., Scott, J. L., Carpenter, D., Ross, R., & Docherty, J. P. (2009) · PubMed · Cited by 625
Weiden, P. J., Kozma, C., Grogg, A., & Locklear, J. (2004) · Psychiatric Services · doi:10.1176/appi.ps.55.8.886 · Cited by 621 · cited 1×
“Many studies [4–6] investigated that hospitalization rates were significantly higher among non-adherent patients compared with adherent ones.”
BackgroundInterventions to Improve Medication Adherence in Schizophrenia
Zygmunt, A., Olfson, M., Boyer, C. A., & Mechanic, D. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.10.1653 · Cited by 541 · cited 1×
“Interventions targeted specifically to problems of non-adherence were more likely to be effective than were more broadly based treatment interventions [13].”
BackgroundKane, J. M., Kishimoto, T., & Correll, C. U. (2013) · World Psychiatry · doi:10.1002/wps.20060 · Cited by 520 · cited 5×
“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×
“Antipsychotic medication adherence plays a key role in patients with schizophrenia, and regular treatment has been proven to ameliorate symptoms and reduce relapse rates [1].”
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Medication adherence among adults with mental illnesses in Oman: A cross-sectional study
Rashdi, F. A., Omari, O. A., & Salmi, N. A. (2026) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1612_25
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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