Discussion
This study demonstrated that the patients who participated in the psychoeducational program were more likely to express positive attitude toward medication and attend the first follow-up appointment after discharge than those in the control group. Five explanations may be possible for the positive results. First, the psychoeducational program was administered to the patients before discharge and continued for one month after discharge. This program might provide knowledge and skills necessary for the time and needs of the patients. It is likely that the continuing care for patients in the transitional period from the hospital to the community is very important for a successful outcomes. Secondly, the program, offered in an individual format, might provide an opportunity to establish trust and a healing relationship between the researcher and the participants. The participants were encouraged to discuss their feelings, express problems/concerns and collaboratively work with the researcher to identify appropriate problemsolving strategies. Thirdly, the program emphasized the benefit of taking medication regularly. Two sessions focusing on pharmacological treatment (such as medication, side effects, and side effect management) were implemented. Despite these two sessions being offered before discharge, the issues of taking medication continuously was repeatedly discussed when the patients were discharged. It is suggested that the nurse contact over time is very important for producing optimal medication compliance. Fourthly, the program provided information relating to stress management skills such as breathing exercise for relaxation. The researcher called these patients to further support them while they were living in the community. As a result, patients received continuous support while facing problems in the community. Finally, during the telephone follow-up sessions, the researcher discussed with patients about the appointment, feelings and concerns about the appointment, and possible difficulties for the follow-up visit. It was found that there were several difficulties for their noncompliance with the follow-up visit, such as the lack of confidence to visit the physician by themselves, perceived family burden, and insufficient money for transportation. These concerns were collaboratively discussed and solved, while the patients were also encouraged to recognize the benefits of the appointment after discharge. As a result, their stress and symptoms could be controlled and managed. This clinical stability would help lead the patients to comply with the first appointment. It can be concluded that the patients in the experimental group reported their improvement of compliance due to several factors such as the acceptance of the illness, the ability to manage the symptoms and stress management skills. As a result, their psychotic symptoms were decreased. These factors could increase the positive attitude toward medication in schizophrenic patients.
Limitation
In this study 4 females refused to participate in the program, suggesting a possible selfselection bias, in that, potential participants who had paranoia or poor insight, and high stigma may have declined participation in the study. In addition, the subjects were required to be discharged to a known address with telephone access. The inclusion criteria for this study eliminated the potential participants who were either homeless, or unable to afford a telephone. This was a quasi-experimental research study, which held a small group of patients and its sample was male only. The evidence documented that gender was associated with attitude toward medications.24 Women were more likely to exhibit positive attitudes toward medications than men. The effectiveness of the program should be tested in a further clinical trial with a larger sample size, including both male and female.
Acknowledgement
We thank Associate Professor Dr. Fongcum Tilokskulchai, and Dr. Prayuk Serisathien for their valuable suggestions and comments. The authors also wish to thank all participants who participated in this study.
Discussion
This study demonstrated that the patients who participated in the psychoeducational program were more likely to express positive attitude toward medication and attend the first follow-up appointment after discharge than those in the control group. Five explanations may be possible for the positive results. First, the psychoeducational program was administered to the patients before discharge and continued for one month after discharge. This program might provide knowledge and skills necessary for the time and needs of the patients. It is likely that the continuing care for patients in the transitional period from the hospital to the community is very important for a successful outcomes. Secondly, the program, offered in an individual format, might provide an opportunity to establish trust and a healing relationship between the researcher and the participants. The participants were encouraged to discuss their feelings, express problems/concerns and collaboratively work with the researcher to identify appropriate problemsolving strategies. Thirdly, the program emphasized the benefit of taking medication regularly. Two sessions focusing on pharmacological treatment (such as medication, side effects, and side effect management) were implemented. Despite these two sessions being offered before discharge, the issues of taking medication continuously was repeatedly discussed when the patients were discharged. It is suggested that the nurse contact over time is very important for producing optimal medication compliance. Fourthly, the program provided information relating to stress management skills such as breathing exercise for relaxation. The researcher called these patients to further support them while they were living in the community. As a result, patients received continuous support while facing problems in the community. Finally, during the telephone follow-up sessions, the researcher discussed with patients about the appointment, feelings and concerns about the appointment, and possible difficulties for the follow-up visit. It was found that there were several difficulties for their noncompliance with the follow-up visit, such as the lack of confidence to visit the physician by themselves, perceived family burden, and insufficient money for transportation. These concerns were collaboratively discussed and solved, while the patients were also encouraged to recognize the benefits of the appointment after discharge. As a result, their stress and symptoms could be controlled and managed. This clinical stability would help lead the patients to comply with the first appointment. It can be concluded that the patients in the experimental group reported their improvement of compliance due to several factors such as the acceptance of the illness, the ability to manage the symptoms and stress management skills. As a result, their psychotic symptoms were decreased. These factors could increase the positive attitude toward medication in schizophrenic patients.
Limitation
In this study 4 females refused to participate in the program, suggesting a possible selfselection bias, in that, potential participants who had paranoia or poor insight, and high stigma may have declined participation in the study. In addition, the subjects were required to be discharged to a known address with telephone access. The inclusion criteria for this study eliminated the potential participants who were either homeless, or unable to afford a telephone. This was a quasi-experimental research study, which held a small group of patients and its sample was male only. The evidence documented that gender was associated with attitude toward medications.24 Women were more likely to exhibit positive attitudes toward medications than men. The effectiveness of the program should be tested in a further clinical trial with a larger sample size, including both male and female.
Acknowledgement
We thank Associate Professor Dr. Fongcum Tilokskulchai, and Dr. Prayuk Serisathien for their valuable suggestions and comments. The authors also wish to thank all participants who participated in this study.
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