Treatment Adherence Among People with Schizophrenia: An Application of the Theory of Planned Behaviour

Abstract

Schizophrenia is a severe and persistent psychiatric disorder that, for most sufferers, responds well to a range of pharmacological and psychosocial treatment options. However, management of symptoms and ability to function independently rely on individuals with a diagnosis of schizophrenia engaging in treatment. This study, employing a qualitative methodology, applied a Theory of Planned Behaviour framework to determine whether people with schizophrenia do make reasoned decisions about treatment adherence and, if so, to identify what are the factors that may influence decision-making. Semi structured interviews were conducted with a purposively selected sample of twelve people living in community settings in parts of the Otago region serviced by the Southern District Health Board (Dunedin City, North and South Otago). Participants had a diagnosis of schizophrenia for which they had received treatment. Theoretical thematic analysis based on the Theory of Planned Behaviour was applied to data. The study found that while all participants had received anti-psychotic medication, they reported limited experience of receiving psychosocial treatment interventions. The main influence on their decisions to adhere to treatment for schizophrenia was their attitude towards treatment, which in turn were influenced by their beliefs about the benefit of treatments (the likelihood that treatment would contribute to a desired outcome or prevent something undesirable happening), which was based on information from a variety of sources. The subjective normative expectations of others and the perceptions of what people with schizophrenia known to the respondents were doing in regard to treatment was also found to influence treatment decisions. Overall the study found that people with schizophrenia do make reasoned decisions to adhere to treatment. This finding has implications for professionals working with people with a diagnosis of schizophrenia who do not adhere to treatment tasks. It the reasons for non-adherence can be identified then they can be addressed utilising psychosocial treatment interventions.