Introduction
Schizophrenia is a common mental illness, for statistics released in 2014 show that at least 24 million people worldwide are affected.1 In 2010, according to the Central Statistics Agency in Indonesia, the prevalence of people with schizophrenia (PWS) was estimated to have increased to around 2 million
people, about 1% to 2% of the total population.2 Currently, the main treatment for people with psychotic disorders, including PWS, is pharmacotherapy.3 However, many PWS are non-adherent with their medications. The non-adherence rate in globally ranges from 40-50%,4 while in Indonesia this has been reported to be around 41.7%5; and the majority (64%) were at a moderate level of adherence.6 Non-adherence to medication has several serious impacts on PWS: relapse, re-hospitalization, difficulty experienced in achieving remission, suicide attempts, clinical burden, and cost.7 In consideration of these impacts of non-adherence, this study was directed at developing an intervention to improve medication adherence in PWS.
A meta-analysis investigating interventions to improve medication compliance in PWS found that that there was a significant improvement in medication adherence when patient-tailored strategies were used.8 Self-tailoring is based on the principles of learning for behaviour change and self-management program skills that include decision-making and problem-solving.9 Prior research also suggests that a self-management program can enhance PWS’ adherance to medication.10,11 Self-management not only requires an individual’s ability but also needs collaboration with family to control their health condition.12,13 A meta-analysis of studies has demonstrated that educational programs which include family members have a better outcome in reducing symptoms and preventing relapse than educational programs that only involve PWS.14
In Indonesia, after discharge from a psychiatric hospital, the family often needs to take care of PWS at home and take them for regular check-ups to get medication. This can be challenging for there are only a few community health centers which stock and provide the psychiatric medications, or have self-help groups. Therefore, the role of family, especially the main caregiver, is very important, and the family needs to be reminded to assist with continuous and consistent medication adherance. One study has revealed a lack of family support regarding medication adherence among PWS in Indonesia, 15 but overall there is a lack of research in the area.
As mentioned, self-management programs involving family support have been reported as very beneficial for PWS, but such programs have not been undertaken in Indonesia. Hence, this study examined the effect of the Self-management Family Participation Program (SMFPP) for medication adherence among PWS.