Related Experiment Video
Updated: Sep 26, 2025

Development of a Virtual Reality Assessment of Everyday Living Skills
Published on: April 23, 2014
Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and
Wen Ling Hsieh1, Shin Ting Yeh2, Wen I Liu1
1School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
Background:
Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators.
Purpose:
To examine the insight-medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude.
Patients And Methods:
This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains.
Results:
In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect.
Conclusion:
In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight.
Related Concept Videos
Drug Therapy
Antianxiety Medications
Psychosis: Goals of Pharmacotherapy
Modeling in Therapy
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in...
Psychological and Sociocultural Causes of Schizophrenia
Psychosis and Antipsychotic Drugs: Overview
Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...

