| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 105 === Background purpose: Schizophrenia is a chronic illness that requires medication to stabilize delusions, hallucinations or speech and behavioral disorders. However, almost half of the current patients have poor medication adherence, causing disease recurrence or repeated hospitalization, which have a major impact on medical costs. Furthermore, the consideration of motivation is the key to behavioral prediction, therefore this study explores the multi-aspect factors affecting the medication adher-ence of community-dwelling schizophrenia patients and the effects of the motivation to take medications on medication adherence.
Study methods: This study is a cross-sectional convenience sampling. The study locations are the psychiatric hospitals in the north and middle parts of Taiwan. The study subjects are the community-dwelling schizophrenia patients under outpatient clinic, psychiatric day care center and home care treatment. Self-surveys with good reliability/validity and surveys done by trained nurses were collected between Sep-tember 2016 and April 2017. The variables are: 1. Patient demographics (gender, age, marital status, educational level and occupation); 2. Disease status (duration, admis-sion count, overall function and psychiatric symptoms); 3. Treatment (medication type, route of administration, frequency and side effects); 4. Disease management (thera-peutic alliance, insight, attitude towards taking medication and medical social support); 5. Motivation to take medication; 6. Medication adherence. SPSS 21.0 is the statistics program used to perform inferential statistical analysis with descriptive statistics, independent-sample t-test, ANOVA, pearson's correlation and hierarchical regression.
Study results: A total of 373 patients completed the surveys. The medication ad-herence of the community-dwelling schizophrenia patients is 47.2%, in which clinics have the highest medication adherence rate (61.9 %), followed by day care (56.3 %) and ending with home care (40.6 %). Admission count (r = - .19), overall function (r = .17), psychiatric symptoms (r = - .18), side effects (r = - .12), therapeutic alliance (r = .39), insight (r = - .31), attitude towards taking medication (r = .59), medical social support (r = .25) and motivation (r = .43) all have significant correlations with medi-cation adherence. In the overall regression model, admission count (β = - .09), overall function (β = .15), attitude towards taking medication (β = .48) and motivation (β = .13) can predict medication adherence, with the explanatory power reaching 45.9%. After controlling the patient, disease status and treatment factors, there is a mediating effect between medication adherence and the motivation to take medication toward the disease management factors of therapeutic alliance, disease insight, attitude on taking medication and medical social support. The indirect effects are 0.173, -0.114, 0.078 and 0.145 respectively.
Conclusion and recommendation: The poor medication adherence rate of the community-dwelling schizophrenia patients is more than half. Admission count, over-all function, attitude on taking medication and motivation can predict medication adherence. The motivation to take medication can mediate the effects of disease man-agement factors toward medication adherence. This study recommends the improvement of the impact factors of medication adherence as well as the development of the disease management factors based on the motivation to take medication, which have positive benefits towards strengthening medication adherence.
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