Understanding Drug-taking Behavior and Factors influencing in People with Schizophrenia: A Qualitative Study
Keywords:
Schizophrenia, pharmacist-led intervention, home care, FGDs
Abstract
Schizophrenia is a chronic mental disorder that significantly impacts patients, families, and healthcare systems. Medication non-adherence poses a major challenge, leading to relapse and increased healthcare costs. The Si-Care (Schizophrenia Care) program, a pharmacist-led home care intervention, was developed to improve medication adherence and therapy outcomes. This study aimed to refine the Si-Care program and its educational booklet using focus group discussions (FGDs) with healthcare professionals. FGDs were conducted with 13 healthcare professionals, including pharmacists, psychiatrists, nurses, and general practitioners, in Banjarmasin, Indonesia. Participants were recruited purposively for their experience in schizophrenia care. Discussions explored the feasibility and components of the Si-Care program and gathered recommendations for optimizing the educational booklet. Data were analyzed thematically to identify key themes and patterns. Four themes emerged from FGDs, including the importance of interdisciplinary collaboration, the perceived benefits of the program, the expanded role of pharmacists, and the need for management and regulatory support. Participants emphasized the program’s potential to enhance medication adherence through comprehensive counseling, education, and monitoring. For the booklet, recommendations included using plain language, incorporating visual aids, and addressing emergency signs for schizophrenia. Practicality and cost-effectiveness were highlighted as essential considerations. The Si-Care program presents a promising pharmacist-led intervention for improving schizophrenia care. Multidisciplinary input refined the program and its educational materials, enhancing their feasibility and relevance. Future research should focus on pilot testing to evaluate the program’s scalability and impact on patient outcomes, incorporating feedback from patients and families.
References
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Lippi, G. (2016). Schizophrenia in a member of the family : Burden , expressed emotion and addressing the needs of the whole family. South African Journal of Psychiatry, 22(1), 1–7.
Loots, E., Goossens, E., Vanwesemael, T., Morrens, M., Van Rompaey, B., & Dilles, T. (2021). Interventions to improve medication adherence in patients with schizophrenia or bipolar disorders: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18, 1–22. https://doi.org/10.3390/ijerph181910213
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Milosavljevic, A., Aspden, T., & Harrison, J. (2018). Community pharmacist-led interventions and their impact on patients’ medication adherence and other health outcomes: a systematic review. International Journal of Pharmacy Practice, 1–11. https://doi.org/10.1111/ijpp.12462
Mohiuddin, A. (2018). Patient Education: Effective Vision for True Compliance. Advanced Nursing & Patient Care International Journal, 1(3), 1–10. https://chembiopublishers.com/ANPCIJ/ANPCIJ180012.pdf
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Spaniel, F., Bakstein, E., Anyz, J., Hlinka, J., Sieger, T., Hrdlicka, J., Görnerová, N., & Höschl, C. (2016). Relapse in schizophrenia: Definitively not a bolt from the blue. Neuroscience Letters, 1–7. https://doi.org/10.1016/j.neulet.2016.04.044
Tan, Y. M., Chong, C. P., & Cheah, Y. C. (2019). Impact of hospital pharmacist-led home medication review program for people with schizophrenia : A prospective study from Malaysia. Journal of Applied Pharmaceutical Science, 9(07), 34–41. https://doi.org/10.7324/JAPS.2019.90705
Tiwari, R. R., Pandey, B., & Chaudhari, K. S. (2023). Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings. Cureus, 15(7), 1–5. https://doi.org/10.7759/cureus.41279
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
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Ahamad, T., Ananda, K. N., Ghanashyam, S. D., & Bheemsain V, T. (2019). Effectiveness of Clinical Pharmacist Led Collaborative Approach Towards Medication Adherence in Patients With Schizophrenia Receiving Atypical Antipsychotics At Tertiary Care Hospital. International Journal of Research in Ayurveda and Pharmacy, 10(3), 87–91. https://doi.org/10.7897/2277-4343.100369
Ambikile, J. S., & Iseselo, M. K. (2023). Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania. PLOS Global Public Health, 3(1), 1–17. https://doi.org/10.1371/journal.pgph.0001518
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., McGrath, J. J., & Whiteford, H. A. (2018). Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016. Schizophrenia Bulletin, 44(6), 1195–1203. https://doi.org/10.1093/schbul/sby058
Chow, E. P., Hassali, M. A., Saleem, F., & Aljadhey, H. (2015). Effects of pharmacist-led patient education on diabetes-related knowledge and medication adherence: A home-based study. Health Education Journal, 1–13. https://doi.org/10.1177/0017896915597021
Dewan, P. (2015). Words Versus Pictures: Leveraging the Research on Visual Communication. Partnership: The Canadian Journal of Library and Information Practice and Research, 10(1), 1–10. https://doi.org/10.21083/partnership.v10i1.3137
Ee, C., Lake, J., Firth, J., Hargraves, F., de Manincor, M., Meade, T., Marx, W., & Sarris, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health Systems, 14(83), 1–16. https://doi.org/10.1186/s13033-020-00410-6
Eticha, T., Teklu, A., Ali, D., Solomon, G., & Alemayehu, A. (2015). Factors associated with medication adherence among patients with schizophrenia in Mekelle, Northern Ethiopia. PloS One, 1–11. https://doi.org/10.1371/journal.pone.0120560
Habibi, R., Nayer, M. S., & Zadeh, M. K. (2015). Educational Needs of Families of Patients with Schizophrenia : A Literature Review. International Journal of Medical Reviews, 2(2), 250–255.
Hanlon, C., Wondimagegn, D., & Alem, A. (2012). Lessons learned in developing community mental health care in East and South East Asia. World Psychiatry, 9(3), 185–189. https://doi.org/10.1002/j.2051-5545.2012.tb00129.x
Hasan, A. A., Callaghan, P., & Lymn, J. S. (2015). Evaluation of the impact of a psychoeducational intervention for people diagnosed with schizophrenia and their primary caregivers in Jordan: A randomized controlled trial. BMC Psychiatry, 15(72), 1–10. https://doi.org/10.1186/s12888-015-0444-7
Higashi, K., Medic, G., Littlewood, K. J., Diez, T., Granström, O., & De Hert, M. (2013). Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology, 3(4), 200–218. https://doi.org/10.1177/2045125312474019
Howe, J., & Lindsey, L. (2023). The role of pharmacists in supporting service users to optimise antipsychotic medication. International Journal of Clinical Pharmacy, 45, 1293–1298. https://doi.org/10.1007/s11096-023-01630-9
Jenkins, R., Othieno, C., Okeyo, S., Aruwa, J., Kingora, J., & Jenkins, B. (2013). Health system challenges to integration of mental health delivery in primary care in Kenya-perspectives of primary care health workers. BMC Health Services Research, 13, 1–8. https://doi.org/10.1186/1472-6963-13-368
Karge, R. A., Curtain, C. M., & Salahudeen, M. S. (2023). Community Pharmacists’ Role in Reducing the Incidence of Cardiometabolic Adverse Drug Events in Schizophrenia: Insights from Mental Health Professionals. Medicina, 59(2052), 1–12. https://doi.org/10.3390/medicina59122052
Keating, D., McWilliams, S., Schneider, I., Hynes, C., Cousins, G., Strawbridge, J., & Clarke, M. (2017). Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode. BMJ Open, 7(1), e013881. https://doi.org/10.1136/bmjopen-2016-013881
Lauzier, S., Grégoire, J.-P., Lesage, A., & Moisan, J. (2013). Community pharmacy loyalty among individuals with schizophrenia. Research in Social & Administrative Pharmacy : RSAP, 9, 806–816. https://doi.org/10.1016/j.sapharm.2013.01.007
Lippi, G. (2016). Schizophrenia in a member of the family : Burden , expressed emotion and addressing the needs of the whole family. South African Journal of Psychiatry, 22(1), 1–7.
Loots, E., Goossens, E., Vanwesemael, T., Morrens, M., Van Rompaey, B., & Dilles, T. (2021). Interventions to improve medication adherence in patients with schizophrenia or bipolar disorders: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18, 1–22. https://doi.org/10.3390/ijerph181910213
Lutfiyya, M. N., Chang, L. F., McGrath, C., Dana, C., & Lipsky, M. S. (2019). The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018. PLoS ONE, 14(6), 1–18. https://doi.org/10.1371/journal.pone.0218578
Masoumi, T., Shafaroodi, N., & Razvan, Z. (2018). Participation of people with schizophrenia in everyday life: Family’s perspective. Iranian Rehabilitation Journal, 16(3), 297–305. https://doi.org/10.32598/irj.16.3.297
Milosavljevic, A., Aspden, T., & Harrison, J. (2018). Community pharmacist-led interventions and their impact on patients’ medication adherence and other health outcomes: a systematic review. International Journal of Pharmacy Practice, 1–11. https://doi.org/10.1111/ijpp.12462
Mohiuddin, A. (2018). Patient Education: Effective Vision for True Compliance. Advanced Nursing & Patient Care International Journal, 1(3), 1–10. https://chembiopublishers.com/ANPCIJ/ANPCIJ180012.pdf
Morony, S., McCaffery, K. J., Kirkendall, S., Jansen, J., & Webster, A. C. (2017). Health Literacy Demand of Printed Lifestyle Patient Information Materials Aimed at People With Chronic Kidney Disease: Are Materials Easy to Understand and Act On and Do They Use Meaningful Visual Aids? Journal of Health Communication, 00, 1–9. https://doi.org/10.1080/10810730.2016.1258744
Nealon, J., Taurel, A.-F., Capeding, M. R., Tran, N. H., Hadinegoro, S. R., Chotpitayasunondh, T., Chong, C. K., Wartel, T. A., Beucher, S., Frago, C., Moureau, A., Simmerman, M., Laot, T., L’Azou, M., & Bouckenooghe, A. (2016). Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial. PLoS Neglected Tropical Diseases, 10(8), e0004918. https://doi.org/10.1371/journal.pntd.0004918
Ng, R., El-Den, S., Stewart, V., Collins, J. C., Roennfeldt, H., McMillan, S. S., Wheeler, A. J., & O’Reilly, C. L. (2021). Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review. Australian & New Zealand Journal of Psychiatry, 00(0), 1–24. https://doi.org/10.1177/00048674211048410
Pérez-Surio, A. F. (2017). Second-Generation Antipsychotics Clinical Pharmacy Plan Developed from Hospital Pharmacy to Primary Health Care. Pharmacy & Pharmacology International Journal, 5(4), 127–129. https://doi.org/10.15406/ppij.2017.05.00126
Raynsford, J., Dada, C., Stansfield, D., & Cullen, T. (2020). Impact of a specialist mental health pharmacy team on medicines optimisation in primary care for patients on a severe mental illness register: a pilot study. European Journal of Hospital Pharmacy : Science and Practice, 27, 31–35. https://doi.org/10.1136/ejhpharm-2018-001514
Reilly, S., Hobson-Merrett, C., Gibbons, B., Jones, B., Richards, D., Plappert, H., Gibson, J., Green, M., Gask, L., Huxley, P., Druss, B., Planner, C., BG, D., & CL, P. (2024). Collaborative care approaches for people with severe mental illness (Review). Cochrane Database of System Reviews, 5, 1–142. https://doi.org/10.1002/14651858.CD009531.pub3.www.cochranelibrary.com
Roberto, P., Brandt, N., Onukwugha, E., Perfetto, E., Powers, C., & Stuart, B. (2017). Adherence to antipsychotic therapy: Association with hospitalization and Medicare spending among Part D enrollees with schizophrenia. Psychiatric Services, 68(11), 1185–1188. https://doi.org/10.1176/appi.ps.201600434
Roquini, G. R., Avelar, N. R. N., Santos, T. R., Oliveira, M. R. A. de C., Neto, N. M. G., de Sousa, M. R. M. G. C., & Trevisan, D. D. (2021). Construction and validation of an educational booklet to promote adherence to oral antidiabetics. Cogitare Enfermagem, 26, 1–12. https://doi.org/10.5380/CE.V26I0.80659
Spaniel, F., Bakstein, E., Anyz, J., Hlinka, J., Sieger, T., Hrdlicka, J., Görnerová, N., & Höschl, C. (2016). Relapse in schizophrenia: Definitively not a bolt from the blue. Neuroscience Letters, 1–7. https://doi.org/10.1016/j.neulet.2016.04.044
Tan, Y. M., Chong, C. P., & Cheah, Y. C. (2019). Impact of hospital pharmacist-led home medication review program for people with schizophrenia : A prospective study from Malaysia. Journal of Applied Pharmaceutical Science, 9(07), 34–41. https://doi.org/10.7324/JAPS.2019.90705
Tiwari, R. R., Pandey, B., & Chaudhari, K. S. (2023). Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings. Cureus, 15(7), 1–5. https://doi.org/10.7759/cureus.41279
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
Verma, P. K., Walia, T. S., Chaudhury, S., & Srivastava, S. (2019). Family psychoeducation with caregivers of schizophrenia patients : Impact on perceived quality of life. Industry Psychiatry Journal, 28, 19–23. https://doi.org/10.4103/ipj.ipj
Wardani, L. K., & Priyanto. (2022). The Influence of Family Psycoeducation on the Ability of Families in Careing for Schizophrenia Patients in Sumberpucung Village Community Health Center, Sambigede Village Kecamatan Sumberpucung, District. Poor. Journal of Global Research in Public Health, 7(2), 141–148. https://doi.org/10.30994/jgrph.v7i2.408
WHO. (2022). Schizophrenia. Www.Who.Int/News-Room/Fact-Sheets/Detail/Schizophrenia. https://www.who.int/news-room/fact-sheets/detail/schizophrenia
World Health Organization. (2003). Mental health policy and service guidance package. Organization of Services for Mental Health. Geneva. https://iris.who.int/handle/10665/333104
Published
2025-09-11
How to Cite
Noor cahaya, Susi Ari Kristina, Anna Wahyuni Widayanti, & James Green. (2025). Understanding Drug-taking Behavior and Factors influencing in People with Schizophrenia: A Qualitative Study. Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.18268
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Section
Research Article
