Mental Health Nursing

to establish a link between EPS and compliance in patients receiving
long-term anti-psychotic treatment.
There is some evidence that a number of other factors may influence
compliance: McEvoy et al. (1989) suggested that compliance was substantially
higher in patients whose medication was supervised by a family
member; Swofford et al. (1996) found that compliance rates were much
lower in patients with a co-morbid substance misuse diagnosis. Other
factors that are suggested within the literature as affecting compliance, but
that lack any empirical evidence, include the complexity of treatment
regimes (Parkin et al., 1976) and the patient’s socio-cultural background
(Piatkowska and Farnill, 1992).
Factors that enhance compliance
Adams and Howe (1993) examined factors that were likely to predict
good compliance in 44 psychotic in-patients. The greater the number of
indirect benefits of medication (i.e., ‘keeps me out of hospital’ or ‘it
allows me to make new friends’), the more compliant patients were.
Similar results were reported by Chan (1984) who observed that compliant
patients had generally derived positive benefits from medication.
Addressing insight, beliefs about treatment, side-effects and the other
factors that influence compliance may improve compliance, and consequently
the health, of people with schizophrenia.
Summary of reasons why patients do not comply
Medication management 225
• Antipsychotic medication does not achieve its clinical potential.
• Fifty per cent of patients are non-compliant with medication.
• Factors that affect compliance include patients’ awareness of their illness,
their beliefs about treatment, the side-effects they experience
from medication and their use of non-prescribed substances.
Assessment of factors that affect compliance
As the previous section demonstrated, there is a high level of noncompliance
with medication. Three specific issues were identified as being
relevant: insight into their illness, beliefs about treatment and side-effects
of anti-psychotic medication. Measures are available that allow these
issues to be quantified in a way that is both valid and reliable, however.
Consequently, careful assessment of these factors will provide an important
basis from which interventions may develop to increase compliance.