The effectiveness of compliance therapy on drug attitude among schizophrenic patients: a systematic review.

BACKGROUND: Schizophrenia is one of the most severe mental illnesses. Studies have found that 25% to 80% of all schizophrenic patients are non-compliant in medication-taking. Non-compliance of medication-taking is associated with higher readmission rates that result from relapses. Compliance therapy has been developed to modify negative beliefs toward medication and aims to improve drug attitude toward medication-taking. However, the effect of compliance therapy on drug attitude among schizophrenic patients is unclear.

OBJECTIVES: The objective of this review was to systematically review the available evidence with regards to the effect of compliance therapy on improving attitudes toward medication among schizophrenic patients.

INCLUSION CRITERIA: People diagnosed with schizophrenia, schizophrenia-form disorder, delusion disorder, schizo-affective disorder. TYPES OF INTERVENTION(S): The review considered studies that evaluated any form of compliance therapy. The comparator was standard care. TYPES OF STUDIES: The review considered randomized controlled trials. TYPES OF OUTCOMES: Drug attitude measured by the Drug Attitude Inventory.

SEARCH STRATEGY: Database searches included MEDLINE, CINAHL, EMBASE, Science Direct, SocIndex, PsycINFO, ERIC, the Web of Science, the National Central Library and the Chinese Electronic Periodical Services databases. Searches were limited to English and Chinese. Search was limited to articles published from 1983 to 2013.

METHODOLOGICAL QUALITY: Two reviewers independently appraised the studies using the standardized critical appraisal checklist for randomized control trial and pseudo-randomized trails designed by Joanna Briggs Institute. Disagreements were resolved through discussion.

DATA EXTRACTION: A standardized data extraction tool from the Joanna Briggs Institute was used. Data were extracted by two reviewers independently.

DATA SYNTHESIS: Due to the concern of heterogeneity, meta-analysis was not considered as an appropriate approach to synthesize data in the current review. A narrative summary was therefore carried out.

RESULTS: Three randomized controlled trials met the inclusion criteria. Two studies compared compliance therapy to standard care and both found compliance therapy to significantly improve drug attitude (Drug Attitude Inventory: 1 randomized controlled trial, n=28, mean difference between groups: 4.32, 'p'=0.001; 1 randomized controlled trial, n=47 mean difference between groups: 2.2, 'p<0.001').However, the other study reported that there was no statistically significant difference in the drug attitude score between the two groups (Drug Attitude Inventory: n=50, mean difference between groups: -2.1 'p=0.32').

CONCLUSIONS: The present review found that the majority of the included studies identified an effect of compliance therapy in improving drug attitude. However, the evidence is still weak as the outcome was from three small and heterogeneous studies. Standardization of the compliance therapy and well-designed study is needed to test the effect in the future. Only then, can the therapy be considered to improve attitude toward medication taking among schizophrenic patients.