07/18/2024
By Maureen Martin

The Zuckerberg College of Health Sciences, Solomont School of Nursing, invites you to attend a doctoral dissertation defense by William R. Chadbourne on "The Experience of Medication Adherence Among Psychiatric Patients in the Time of a Pandemic: A Qualitative Study."

Date: Monday, July 29, 2024
Time: 2:30 to 5:30 p.m.
Location: This will be a virtual defense via Zoom. Those interested in attending should email William_Chadbourne@student.uml.edu and committee chair Ainat_Koren@uml.edu at least 24 hours prior to the defense to request access to the meeting.

Committee:

  • Chair Ainat Koren, Ph.D., DNP, PMHNP, Professor and Ph.D. Program Director, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell
  • Ramraj Gautam, Ph.D., Associate Teaching Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell
  • Mechelle Plasse, Ph.D., RN, PMHNP-BC, PMHCNS-BC, Assistant Professor of Nursing and Psychiatry, UMass Worcester

Abstract:

Background: Maintaining adherence to a medication regimen is essential to symptom control of any major mental illness. Prior to the pandemic, the rates of medication nonadherence in people with psychiatric illness ranged from 50% to 66% (Chang et al., 2015; Tasman et al., 2015). When COVID-19 rates rose during the pandemic, there were disruptions on a societal level that affected the supply chain, employment, economics, and the healthcare system. Many clients needed adjustments to their current medications, new medications added to their regimen, and clinical interventions during the ongoing pandemic (Gobbi et al., 2020).

Aim: This dissertation consists of two manuscripts: a meta-ethnography and a qualitative descriptive study.
The meta-ethnography describes the influencers on a client that can affect medication adherence positively or negatively. The interrelational impact that influencers have on medication adherence guided the interviews in the qualitative descriptive study.

The aim of the meta-ethnography was (1.) to gain a better understanding of clients' perspectives and behaviors related to medication adherence and (2.) to identify common or differing influences on adherence behavior specifically for clients diagnosed with bipolar disorder, schizophrenia, or major depressive disorder.

The qualitative study's specific aim was to explore the impact that the COVID-19 pandemic had on medication adherence for people with pre-pandemic psychiatric diagnoses. Specifically, this study addressed the research question: What is the experience of individuals with pre-existing psychiatric conditions on their medication adherence during the COVID-19 pandemic?

Method: The meta-ethnography used a systematic search of qualitative studies published from 2005 to 2024, and twelve studies were identified as appropriate for inclusion. The approach for this meta-ethnography followed the methodology established by Noblit and Hare (1988).

The qualitative study used a qualitative description design to explore the perceptions of medication adherence. It examined the experiences of individuals with pre-existing psychiatric conditions on their medication adherence behaviors during the COVID-19 pandemic. A semi-structured interview guide with open-ended questions, based on the Health Belief Model (HBM) underpinnings, was utilized for this qualitative descriptive study. Individual interviews were conducted via the Zoom platform. Data was analyzed using NVivo 14 for PC.

Findings: The meta-ethnography found four major metaphors regarding the clients’ perceptions of medication adherence: the influence of recognizing and accepting the diagnosis, the influence of the client’s role in taking medication, influencers towards negative adherence behaviors, and influencers towards positive medication adherence.

The qualitative study found five significant themes that correlated to three components of the HBM. Perceived barriers included social isolation, lack of social support, and disruption of treatment services. Perceived strengths included some COVID-19 rules reducing stigma, and telehealth was good during the pandemic. One theme that aligned with Cues to Action was that establishing a routine was important.

Conclusions: The complexities of medication adherence were evident by performing the meta-analysis and conducting the qualitative descriptive research. The pandemic added another layer of influence on medication adherence behaviors. Although barriers were noted during the pandemic, there were also positive influences on adherence. This dissertation adds insight into those behaviors and how they may guide future research and interventions should another disaster occur.