Families Play an Important Role in Medication Adherence Among Latinos with Schizophrenia

Purpose:  Medication nonadherence among Latinos with schizophrenia has been found to be as high as 60%, representing a great obstacle in the treatment process for this group.  However, little is known about family perceptions of medication use, and how these beliefs may extend to treatment.  Given that the majority of Spanish speaking Latinos with schizophrenia live with family, it is important to examine factors that may influence adherence, such as cultural perceptions of medication among clients and their family support system.  This study explored perceptions of medication and its use with Latinos with schizophrenia and their key family members who participated in a culturally based family psychoeducation intervention.   

Methods:  Purposive sampling was used to collect data from 34 participants (20 key family members and 14 clients) who were part of a larger NIMH funded culturally based family psychoeducation development study for Latinos with schizophrenia receiving community-based mental health services in an urban public setting.  The intervention utilized a family group format without direct participation from clients.  Using qualitative methods, semi-structured interviews were conducted in the participants’ preferred language by a bilingual/bicultural interviewer.  Informed by grounded theory, interview transcriptions were analyzed by bilingual/bicultural team members and included development of codes using constant comparison that resulted in themes and subthemes.

Results:  Family members were primarily Spanish speaking while clients were predominantly bicultural/bilingual.  Salient themes emerged indicating facilitators and obstacles to medication and its use for treatment.  Families had an important role in providing support to clients with medication adherence.  Because families had daily contact with clients, they were able to identify when clients were not taking their medication due to changes in their behavior (he begins to get upset and even his sister notices the difference).  Family members would then employ various efforts including accompanying clients to their appointments and providing them with reminders to take their medication.  Families and clients also mentioned the use of complimentary treatment and viewed it as congruous with their prescribed treatment (herbs and teas, gluten free).  In addition, clients and family members expressed concern with medication burden, which appeared to affect their support and adherence to medication (don’t feel well taking so much medication).  Nevertheless, families considered medication to be an important component of treatment particularly because of the knowledge they gained from the intervention regarding the illness (helped me learn more about his problem).        

Implications:  Families provided tangible support for client medication use and believed it was critical to their loved ones’ continued recovery.  Complimentary treatment was also employed, but it did not appear to dissuade clients or their families from medication use.  Medication burden continued to be a concern among participants.  Overall, families expressed that information gained from the intervention gave them the tools to understand the illness and the value of treatment adherence.  As such, it provides support for the relevance of the culturally based family psychoeducation model in practice among this underserved group.