PhD in Nursing Science Program

The Role of Sense of Belonging and Hope in Medication Adherence in Schizophrenia

Dissertation under the direction of Dr. Sheila Ridner 

Schizophrenia is a chronic and often debilitating mental illness with serious impact on individuals, families and society, particularly when the disorder is untreated. Medication non-adherence in schizophrenia is a significant issue, with estimates of non-adherence ranging from 50-90%. The majority of individuals with schizophrenia experience periods of non-adherence at some point during their illness. Medication non-adherence can result in illness relapse, hospitalization, poorer outcomes and increased financial burden for patients and society. The purpose of this descriptive-correlational cross-sectional research was to explore associations of sense of belonging and hope with medication adherence in persons with schizophrenia, controlling for the potentially confounding variable of therapeutic alliance. A purposive sample of sixty-five participants were recruited from three community mental health centers in Davidson County, Tennessee. Participants were screened for comprehension of informed consent using the Evaluation of Informed Consent instrument. Univariate analyses found no significant correlations between medication adherence and sense of belonging or therapeutic alliance. After controlling for therapeutic alliance, findings did not support the hypothesized relationship between sense of belonging and medication adherence ( p =0.334). There were, however, significant relationships among the variables medication adherence, hope, and therapeutic alliance. Using the clinical categories of adherence, there remained a statistically significant increase in the likelihood of being “adherent” using the clinical category with increasing hope values (OR=1.16, 95% CI=1.01-1.34, p = 0.038). This research is the only known quantitative study exploring the role of hope and sense of belonging on medication adherence in persons diagnosed with schizophrenia. As such, the study contributes invaluable information to the extensive body of research on the ongoing dilemma of medication non-adherence in this population. These findings study may guide future research on hope and medication adherence to positively impact medication non-adherence in schizophrenia.