An intercultural perspective toward supporting antipsychotic medication adherence in clinical practice

Abstract

In the UK, the incidence of schizophrenia appears highest in Black Caribbean and Black African communities (four- to six-fold that of the White British population). The incidence of psychosis in other minority ethnic groups is also raised, but to a lesser magnitude. Although there are numerous environmental confounding factors, the data stresses the importance of optimising treatment in high-risk (minority) groups. Antipsychotic nonadherence is the most common reason for schizophrenia relapse, and is associated with increased rates of relapse, readmission to hospital and suicide. This article examines available literature to discover how culture can affect antipsychotic nonadherence, and considers culture-based solutions that could enhance antipsychotic adherence. Acknowledging the importance of the therapeutic alliance and sociocultural aspects in antipsychotic adherence, I argue that current cultural competence training provided to clinicians is inadequate. Organisational- and system-level approaches are required to reduce oppressive practise and promote culturally competent, person-centred care.

Improving Medication Adherence among Patients with Schizophrenia in the Sunyani Municipality, Ghana: The Role of Therapeutic Alliance

“…These, the researchers believe, could have informed respondents' decision to seek or not to seek care from the hospital, leading to the low mean MARS score. Poor adherence or non-adherence to antipsychotic medications accounts for most of the relapses in schizophrenia, resulting to frequent hospital readmissions, suicidal behaviours (Zacharia, 2022), violence (Hsieh et al, 2022), and poor cognitive, clinical and functional outcome (Tessier et al, 2017). This suggests that many of our respondents could be at a heightened risk of poor disease prognosis and suggests a critical need for intervention from relevant stakeholders; the Ministry of Health, Ghana, the Ghana Health Service (GHS), the Ghana Mental Health Authority, the Bono Regional Health Directorate, Management of the Bono Regional Hospital and the Sunyani Municipal Hospital, non-governmental organizations (NGOs)…”

“…Several factors affect adherence or non-adherence to medication, including insight (Maqbali et al, 2022), quality of clinician-patient relationship (Deniz et al, 2021), patient's age, marital status (Grover et al, 2021), income status, educational background, socio-familial support, stigma and discrimination (Peña et al, 2021). However, Zacharia (2022) noted that therapeutic alliance was the single most important determinant of medication adherence. Medication adherence refers to the degree to which a patient is able to take their medication as prescribed, including the dosing, timing etc.…”

“…(Kareem & Mahmood, 2022). Poor adherence or nonadherence to antipsychotic medications accounts for most of the relapses in schizophrenia, resulting in several hospital readmissions, suicidal behaviours (Zacharia, 2022), violence (Hsieh et al, 2022), and poor cognitive, clinical and functional outcome (Tessier et al, 2017).…”

RE: An intercultural perspective towards supporting antipsychotic medication adherence in clinical practice

“…I read with great interest Zacharia's Reflections article, 1 which provides an interesting and informative intercultural perspective on antipsychotic medication adherence, with a focus on people from minority ethnic backgrounds in the UK. I strongly support the argument put forward by the author for a ‘relational/intercultural’ approach rather than a ‘cultural literacy’ approach, especially in view of the limitations of cultural competence training and the impossibility of becoming familiar with all the cultures that patients may come from, as highlighted in the article.…”