The goal of mental health services provided by professionals is often to help the patients recover from their condition and start enjoying independent living. However, cases of noncompliance are often rampant in chronic conditions associated with stigma, social isolation, and comorbid substance abuse, as well as the impact of symptom domains on adherence which can either be positive or negative in nature, depression, lack of awareness, and cognitive impairment. It is at the backdrop of these concerns that an interest developed with regards to the relationship that may exist between compliance to mental health medication regimen and improved recovery outcomes, including independent living.
Consequently, the topic for this research seeks to understand the connection between compliance and the health outcomes in mental health cases. As Haddad, Brain, and Scott (2014) note in their study of noncompliance with antipsychotic medication in schizophrenia, the challenge of patients failing to follow the advice offered to them with regards to their medication regime has been with the medical profession since the 4th century BC. Researching on the effect of compliance to mental health medication regimen and improved recovery outcomes will provide insights into strategies that mental health practitioners can employ to ensure that their patients adhere to their medication regime. Insights from the study will also be helpful in promoting better care for patients with mental health problems.
This is an elementary core of this literature review as it enables the focus on the study, the methodology to be used and provides guidance throughout all the stages of review, analysis, and reporting. The fundamental research question that this review seeks to answer is "Does compliance with a mental health medication regimen improve recovery outcomes, such as independent living?
Methodological Framework and Research Methods
Identification of the Issue
Identify cases of compliance to medication regimen
Describe the impact on patient outcomes
Primary Data Sources
Secondary Data Sources
Compliance to mental medication regimen and its effect on recovery outcomes including independent living
Analysis, Interpretation, and Recommendations
Formulate strategies to promote compliance to mental medication regimen among patients to improve recovery outcomes
A methodological framework refers to the different foresight methods that are combined and tailored to perform specific functions at the various stages of the research process in an optimal manner. Depending on the type of research being undertaken, different methodological frameworks are often available for use.
To adequately address the research question and satisfy the objectives of the research, a mixed-method approach will be adopted for the research methodology in which both primary and secondary data will be utilized in making inferences about the research question. Primary data for the research will be collected through questionnaires and interviews conducted on the selected mental health facilities while secondary data will be collected from past studies, government reports, hospital data and other stakeholder data available for review.
Data Bases for Literature Search
Fink (2013) defines literature search as the review of scholarly articles, books and other appropriate sources to deliver an account, summary and critical assessment of the reviewed works concerning the research problem under investigation. The databases that will be used for literature search for this research include those that contain peer-reviewed articles that are relevant to the research topic including CINHAL, Mind, Open Grey, Ovid-Medline, PsychoInfo, PubMed, and Scupous. Specific journals of interest include the British Jornal of Psychiatry, Advances in Psychiatric Treatment, Journal of Mental Health, Psychosis, Psychiatric Services, Mental Health Review Journal and the International Journal of Social Psychiatry among others.
Summary of Five Articles
There is an inclusion criterion that will be used to select articles to be used in this research. The type of studies, the population of interest, year and the language of publication are some of the factors in the inclusion criteria for articles to be used in the research. To be included in the research, the studies should have been primary quantitative with non-randomised; randomized controlled trials; or systematic literature search. Additionally, the population of interest must be individuals with mental health conditions; and the article must have been published in English within the last ten years. The following are the specific articles that will be used for the literature search:
Drymalski, W. M., & Campbell, T. C. (2009). A review of motivational interviewing to enhance adherence to antipsychotic medication in patients with schizophrenia: Evidence and recommendations. Journal of Mental Health, 18(1), 6-15. http://www.tandfonline.com/doi/full/10.1080/09638230802052161The significant contribution that this article will bring to the research is the literature evidence of the prevalence of non-adherence to antipsychotic treatment. The literature discussed in this paper links the behavioral health problems and their impact on non-adherence to the medication regimen and how motivational interviewing can be used to intervene in these cases. Psychiatric patients often develop some behavioral issues that this paper explores in detail and even goes a step further to determine how these issues may impact on the patient's ability to adhere to the specific medical regimen as prescribed by the clinician.
The methodology used in this article is mainly a retrospective review of literature that was published on PubMed and PsycINFO between 1965 and 2006. The results from this article, therefore, cut across the various methods of research and provide an overview of the literature published over the specified period. Unlike other articles, this article offers abundant literature on the link between psychotic problems and non-adherence but fails to provide a conclusion with regards to the effectiveness of motivational interviewing as an intervention mechanism.
Jonsdottir, H., Opjordsmoen, S., Birkenaes, A. B., Engh, J. A., Ringen, P. A., Vaskinn, A., ... & Andreassen, O. A. (2010). Medication adherence in outpatients with severe mental disorders: the relation between self-reports and serum level. Journal of clinical psychopharmacology, 30(2), 169-175. https://journals.lww.com/psychopharmacology/Abstract/2010/04000/Medication_Adherence_in_Outpatients_With_Severe.10.aspxMost patients with mental problems are often treated as outpatients, and therefore cases of non-adherence are likely to be high. This article's specific contribution to this research is the in-depth analysis it provides with regards to the levels of adherence to medical prescription among outpatients with serious mental conditions. Additionally, this article evaluates the validity of self-report rating of adherence which could help shade some light on the effectiveness of self-reporting as an adherence monitoring technique that medical practitioners dealing with patients with mental disorders have made use of for a long time.
The cross-sectional study was a portion of the Norwegian thematic systematized psychosis clinical research of patients with schizophrenia and bipolar disorders and used structured interviews on patients that had been recruited by their clinicians to participate. This study combines biological, clinical and behavioral measures to conclude that there is "fairly good adherence and that there is a good predictive value for a simple self-report measure of adherence. The conclusions for this study are not consistent with many studies in the field and therefore make this review a unique one and highly valuable to my research as it may help shade light on how high levels of compliance can be achieved when dealing with patients with mental health problems.
Magura, S., Rosenblum, A., & Fong, C. (2011). Factors associated with medication adherence among psychiatric outpatients at substance abuse risk. The open addiction journal, 4, 58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526017/This study adds the substance misuse angle to the study of levels of adherence among psychiatric patients. The contribution of this article to the research relates specifically to the effect of a substance misuse history on the level of adherence to medication regimen among psychiatric patients. According to the hypothesis of this article, there are high incidences of non-adherence among psychiatric patients with a history of substance misuse.
The article used the uncontrolled cross-sectional design of patients that had been admitted to the outpatient program between March 2003 and December 2005. Effectively, patients admitted to the program did not have to exhibit a specific substance misuse problem and therefore this was one of the limiting factors of this study as the results cannot be extrapolated to a particular misuse of substance since there are numerous substances that the participants may have been abusing. Confidential personal interviews with patients and the assigned psychiatric diagnoses were used in the process of data collection for the study. The introduction of a possible causative factor regarding substance abuse to the determination of adherence levels among psychiatric patients makes this article an impressive contribution to my research.
Mathes, T., Jaschinski, T., & Pieper, D. (2014). Adherence influencing factorsa systematic review of systematic reviews. Archives of Public Health, 72(1), 37. https://www.ncbi.nlm.nih.gov/pubmed/25671110This document is a systematic review of articles aimed at identifying the various factors that affect adherence in chronic psychiatric conditions. Therefore, the noteworthy influence of this article to my study is the multiple factors that the article discusses that are deemed to influence levels of adherence to medication regimen. While psychiatric patients are already considered to be highly susceptible to no-adherence, this systematic review of reviews shades light to some factors that may have an impact on the level of adherence and therefore provide insights on how these factors can be addressed to promote adherence. The methodology used is a systematic literature search on Medline and Embase for articles published between 1990 and July 2013. Data synthesis for the article was done by two reviewers using a standardized quantitative approach. While this research is primarily a systematic review, its focus on specific factors that affect adherence including higher education, employment, ethnic minorities, and co-payment differentiates this study from others.
Thompson, L., & McCabe, R. (2012). The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry, 12(1), 87. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-12-87While most non-adherence cases are often attributed to the patient, the alliance developed between the clinician and the patient could also play a vital role in determining the level of adherence. This article's significant contribution to my research is its focus on communication and the clinician-patient alliance in assessing the level of adherence among psychiatric patients. According to this article, the clinician-patient alliance should be established through effective communication and the development of high patient engagement such that the patient can, therefore, feel part and parcel of the recovery process and th...
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