Effects of a narrative-based psychoeducational intervention on medication adherence in individuals with...

Medication non-adherence is a significant challenge in the management of schizophrenia, with non-adherence rates ranging from 30 to 70%. Digital interventions may address barriers to adherence and improve outcomes. We aimed to evaluate the efficacy of a narrative-based psychoeducational intervention in improving medication adherence, attitudes, psychological state, and quality of life in individuals with stable schizophrenia.

This multicentre, parallel-group randomised controlled trial with blinded outcome assessment was conducted at seven community rehabilitation centres. Eligible patients (aged 18-60 years) had a diagnosis of schizophrenia (ICD-10) in a clinically stable phase, had normal vision and hearing, and were able to use a smartphone independently. Upon enrolment, participants were randomly allocated (1:1) to either the intervention group or the control group. The intervention group received standard community rehabilitation plus a narrative-based psychoeducational intervention three times per week for 3 months, while the control group received standard community rehabilitation only. Co-primary outcomes were medication adherence and medication attitude, as assessed using validated self-report questionnaires: the Morisky Medication Adherence Scale-8 (MMAS-8) and the Drug Attitude Inventory (DAI-10), respectively, at: baseline (T0, prior to randomization), post-intervention (T1, after 3 months of intervention), 1-month follow-up (T2, 4 months from baseline), and 3-month follow-up (T3, 6 months from baseline). This trial is registered with ClinicalTrials.gov, NCT06175559.

Between Feb 1 and March 25, 2024, 72 participants were enrolled. Two participants withdrew (distance concerns). Data collection continued until October 30, 2024. Among the 70 participants who completed assessments (mean [SD] age, 44.20 [8.06] years; 27 women [38.57%], 43 men [61.43%]), significant between-group differences emerged over time. The psychoeducational intervention group reported greater positive changes than the control group in medication adherence (β = 0.75 [95% CI, 0.10-1.40]; P = 0.02) and medication attitude (β = 2.29 [0.42-4.15]; P = 0.02) at the T1, and the difference was sustained at 3-month follow-up for adherence (β = 1.65 [0.68-2.62]; P < 0.001) and attitude (β = 3.42 [1.38-5.45]; P = 0.001). Older patients showed significantly better outcomes in medication attitudes (β = 1.56 [0.03-3.10]; P = 0.05) and clinical symptoms (β = -2.43 [-4.83 to -0.04]; P = 0.05), while those with lower education levels had significantly better medication adherence (β = 0.93 [0.20-1.67]; P = 0.01) and social relationships (β = 0.87 [0.23-1.52]; P = 0.01).

Our findings suggest that narrative-based psychoeducational interventions can improve medication adherence in individuals with schizophrenia, with sustained effects. Future studies should investigate the long-term effectiveness and implementation of narrative-based psychoeducation interventions in larger and more diverse patient populations.

Shanghai Municipal Science and Technology Commission 2024 "Science and Technology Innovation Action Plan" Medical Innovation Research Field Program, the Shanghai Municipal Education Commission, Shanghai Jiao Tong University 2024 Medical-Industrial Intersection Research Fund, and Shanghai Jiao Tong University Medical-Industrial Interdisciplinary Youth Program.