Predicting Medication Adherence in Schizophrenia: The Role of Reminiscence Functions and the Moderating Effect of Metacognitive Beliefs on the Effect of Insight on Medication Adherence

In the context of schizophrenia, it has been previously held that the more insight a patient has about their condition, the more likely they are to adhere to their medication regimen more closely. However, insight alone may not be enough. Metacognitive beliefs (ideas and assumptions about their own cognitive processes, such as thinking, memory, and attention) serve as a critical factor impacting this relationship, given their association with both improved medication adherence and increased insight. Another key component of insight is one's ability to reminisce. However, no existing studies have explored the link between reminiscence and medication adherence, which could inform the development of appropriate patient interventions. This study aimed to examine the moderating effect of metacognitive beliefs on the relationship between insight and medication adherence and assess the prediction of medication adherence based on reminiscence functions in a sample of patients hospitalized for schizophrenia. This cross-sectional study employed a convenience sampling method to collect data from 224 patients hospitalized for schizophrenia, as administered through interviews with clinical staff. While reminiscence functions were not directly associated with improved medication adherence, this could be due to their relationship with other sociodemographic predictors in the model. It was shown, however, that higher levels of metacognitive beliefs, dominated by dysfunctional metacognitive beliefs, were significantly associated with a reduced effect of insight on medication adherence (p = 0.016). Patients with high levels of dysfunctional metacognitive beliefs struggle with connecting awareness of their condition with the necessity of adhering to medication. Mental health nurses should consider overarching assessments of metacognitive beliefs to further understand medication adherence and its relationship with patient insight.