Concerns about medication and medication use in chronic pain.

This report describes a study of how patients view their pain medications. Two hundred and twenty patients with chronic pain completed a set of 78 items regarding beliefs and concerns about pain medication, a brief measure of medication use, and measures of depression and disability. Item and scale analyses resulted in a 47-item measure, the Pain Medication Attitude Questionnaire (PMAQ), that assesses 7 areas of patient concern: addiction, perceived need, unfavorable scrutiny by others, adverse side effects, tolerance, mistrust in the prescribing doctor, and withdrawal. These seven scales had excellent internal consistency and predictable relations with the measures of medication use, depression, and disability supporting their validity. Correlation analyses highlighted relatively strong associations between concerns about medication and measures of emotional distress and disability, suggesting that these concerns may add significantly to the burden of chronic pain. We suggest that concerns about medication use warrant further study and may deserve clinical attention. PERSPECTIVE: All medication use by chronic pain sufferers is essentially a pattern of patient behavior over time. As such, it appears to be multiply-determined, by beliefs, emotions, bodily sensations, and the social, cultural, and personal learning history that give these experiences their meaning and functions.     

Multicultural influences on pain medication attitudes and beliefs in patients with nonmalignant chronic pain syndromes.

The objective was to develop an integrated review of quantitative and qualitative research regarding the influence of patients' beliefs and attitudes toward pain medication prescribed for the treatment of nonmalignant chronic pain on use of the pain medication. Studies involving patients at least 18 years old with nonmalignant chronic pain were included. Studies of patients with acquired immune deficiency syndrome, cancer, and acute pain were excluded. Medline, CINAHL, PsychInfo, and Cochrane databases from 1985 to 2005 were searched. Reference lists were screened for relevant articles. Abstracts were screened for compliance with the study criteria, and the articles were obtained for those that met criteria. By using a systematic process, each article was subjected to repeated review and data abstracted to the collection sheets. Evidence tables were created to assist with data review. High levels of concern positively correlate with nonadherence, preconceived ideas about when the drug should start working can cause the patient to discontinue it before it begins to work, and patients may perceive that if medication is taken on a regular basis to control pain it may not be effective in the future if the pain increases. Research also showed that if patients perceived the benefits of taking the pain medication to be high, they were willing to risk the side effects.     

Patient-reported perceptions of side effects of antihyperglycemic medication and adherence to medication regimens in persons with diabetes mellitus

BACKGROUND: With recent media attention to drug safety, patients may have heightened concerns about the side effects of medications that may affect their compliance with treatment. OBJECTIVES: The purpose of this study was to determine the proportion of patients with type 2 diabetes mellitus who perceived having experienced side effects of antihyperglycemic medications, the proportion of these patients who communicated their concerns to physicians, and the potential association between the perception of experiencing side effects and adherence to medication regimens. METHODS: Patients with diabetes were identified through the claims of a Midwest US managed care organization, using Health Plan Employer Data and Information Set criteria. Questionnaires were mailed to randomly selected patients. Patients receiving oral antihyperglycemic medications were selected as prospective subjects. Patients were excluded if they were receiving insulin. RESULTS: The responses of 445 patients meeting the study criteria were collected and analyzed. The subjects were pre-dominantly white, with a mean (SD) age of 56 (11) years and a mean duration of diabetes of 7.3 (8.8) years. One hundred forty-eight (33%) subjects reported a perception of having experienced side effects of antihyperglycemic medication; 126 (85%) subjects reported that they had communicated these concerns to their physicians. Analysis of the subjects' responses indicated an association between the perception of having experienced side effects and nonadherence to antihyperglycemic medication regimens (beta=-0.15; P < 0.010). CONCLUSIONS: Nearly one third of subjects with diabetes receiving oral noninsulin antihyperglycemic medications reported a perception of having experienced medication-related side effects. Despite the large portion of subjects who reported that they had communicated these concerns to their physicians, the perception of experiencing medication-related side effects was significantly associated with nonadherence to antihyperglycemic drug regimens.     

Intentional and unintentional nonadherence to antihypertensive medication

BACKGROUND: Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each. OBJECTIVE: To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients. METHODS: Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence. RESULTS: Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting > or = 5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse. CONCLUSIONS: Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.     

Medication use in patients with migraine and medication-overuse headache: the role of problem-solving and attitudes about pain medication

Excessive medication intake is a risk factor for the development of medication-overuse headache (MOH), a condition characterized by an increase of headache frequency to a daily or near-daily pattern. As yet, it is largely unknown why some patients overuse medication. In this study, we examined to what extent attitudes about pain medication, especially perceived need and concerns, and problem-solving are related to MOH. Patients with migraine (n = 133) and MOH with a history of migraine (n = 42) were recruited from a tertiary headache referral center and completed questionnaires measuring problem-solving and attitudes about pain medication. A problem-solving mode aimed at solving pain was associated with a higher need for and concerns about medication intake. Interestingly, in a model accounting for demographic factors and pain intensity, attempts to control pain, need for medication, and concerns about scrutiny by others because of medication intake all had a unique value in accounting for MOH. Results are discussed in terms of how repeated attempts to solve pain may trigger overuse of medication, even in the presence of clear negative consequences.     

Beliefs about antidepressant medication and associated adherence among older Chinese patients with major depression: A cross‐sectional survey

Antidepressant non‐adherence among people with depressive disorder is a major, ongoing public health issue, yet few studies have focused on older adults and their medication adherence. Although treatment adherence is determined by multiple factors, one of the important and modifiable predictors are patients’ attitudes and beliefs about medication. We explored a sample of 135 older Chinese people with major depression, and the relationship between beliefs about antidepressants and medication adherence. Sociodemographic and illness variables were also examined. In all, high antidepressant adherence was reported in 37.8%, moderate adherence in 39.2%, and low adherence in 23%. Ordinal regression analysis showed perceived necessity (P < 0.01) and concern (P < 0.01) about antidepressants were significant influencing factors. Other variables with a positive association with higher adherence were lower average income (P < 0.05), fewer number of prior episodes of depression (P < 0.01), and comorbid anxiety (P < 0.05). The present study highlights low adherence in a sample of older depressed Chinese people, and highlights how beliefs about medication affect adherence. Therefore, more attention should be focused on non‐adherence in older patients, and there is a need to establish accessible and systematic education programmes to correct misconceptions to improve their adherence.     

Preliminary study of chronic pain patients' concerns about cannabinoids as analgesics

OBJECTIVE: This was a preliminary investigation of patients' beliefs about cannabinoids and the associations between those beliefs, beliefs about medication, and personal and pain variables with regard to patients' willingness to try cannabinoids as analgesics. DESIGN: A self-completion questionnaire was used. SETTING: The investigation took place in an outpatient pain clinic. PATIENTS: Sixty-seven patients with chronic pain were involved. OUTCOME MEASURES: The outcome measures were patients' stated willingness to use cannabinoids and the extent of their agreement or disagreement with statements concerning cannabinoids and medicines in general. RESULTS: Fifty-two percent of patients were doubtful about taking cannabinoids: unwillingness was strongly associated with specific concerns about side effects, addiction, tolerance, and losing control but not with general beliefs about medication or personal or medical variables other than age. CONCLUSIONS: The concerns of patients with chronic pain about taking cannabinoids as analgesics may reduce their utility and efficacy; accurate information is required to counter this effect.     

Factors affecting medication adherence in hypertensive patients

BACKGROUND: Adherence to medication is a critical factor in the continued health and well-being of patients with hypertension. Patients' acceptance of medical advice and information may be influenced by their subjective beliefs about their health condition; therefore, it is essential that their beliefs be taken into account when giving health advice or medical treatment. OBJECTIVE: To determine whether a relationship exists between illness attribution, perceived control, and adherence to antihypertensive medications. METHODS: A prospective, cross-sectional survey of hypertensive patients was conducted at the University of Michigan Medical Centers, Hypertension Clinic, Ann Arbor, MI. One hundred two patients with a goal to reduce their blood pressure were included in the study. Written and follow-up telephone survey questions assessing patients' illness attributions, perceived control, and medication adherence were administered. Associations between these variables were analyzed using correlation analyses. RESULTS: The majority of patients (67.7%) were adherent with their hypertensive medications. Patients indicated that modifiable variables were the most common attribution believed to cause hypertension; however, there was no significant relationship to medication adherence. A significant inverse relationship was found between perceived control over hypertension and medication adherence (p < 0.01). CONCLUSIONS: The findings suggest that patients' greater perception of control over trying to reduce blood pressure may result in decreased reliance on medications and subsequent nonadherence to drug therapy. Implications of these findings on pharmacy practice are discussed.     

Determinants of patient adherence to an aerosol regimen

Patient adherence with prescribed inhaled therapy is related to morbidity and mortality. The terms "compliance" and "adherence" are used in the literature to describe agreement between prescribed medication and patient practice, with "adherence" implying active patient participation. Patient adherence with inhaled medication can be perfect, good, adequate, poor, or nonexistent, although criteria for such levels are not standardized and may vary from one study to another. Generally, nonadherence can be classified into unintentional (not understood) or intentional (understood but not followed). Failing to understand correct use of an inhaler exemplifies unintentional nonadherence, while refusing to take medication for fear of adverse effects constitutes intentional nonadherence. There are various measures of adherence, including biochemical monitoring of subjects, electronic or mechanical device monitors, direct observation of patients, medical/pharmacy records, counting remaining doses, clinician judgment, and patient self-report or diaries. The methods cited are in order of more to less objective, although even electronic monitoring can be prone to patient deception. Adherence is notoriously higher when determined by patient self-report, compared to electronic monitors. A general lack of adherence with inhaled medications has been documented in studies, and adherence declines over time, even with return clinic visits. Lack of correct aerosol-device use is a particular type of nonadherence, and clinician knowledge of correct use has been shown to be imperfect. Other factors related to patient adherence include the complexity of the inhalation regimen (dosing frequency, number of drugs), route of administration (oral vs inhaled), type of inhaled agent (corticosteroid adherence is worse than with short-acting beta2 agonists), patient awareness of monitoring, as well as a variety of patient beliefs and sociocultural and psychological factors. Good communication skills among clinicians and patient education about inhaled medications are central to improving adherence.     

Informed consent and general surgeons' attitudes toward the use of pain medication in the acute abdomen

To determine general surgeons' attitudes about the use of pain medications in the acute abdomen, a questionnaire was mailed to all practicing general surgeons in Iowa. The questionnaire sought to determine the frequency with which pain medications were administered either before informed consent was obtained or before the patient with an acute abdomen was examined, and, in cases when pain medications were withheld, the reasons for withholding. The response rate was 72% (131 of 182). Seven percent of patients with an acute abdomen received pain medications by a general surgeon before being seen and 22% received pain medication by another physician in the emergency department (ED). Fifty-three percent of general surgeons responded that they believe pain medications preclude a patient from signing a valid informed consent; 78% reported that concerns about informed consent enter into their decision to withhold pain medications. Sixty-seven percent agreed that pain medications interfere with diagnostic accuracy, and 82% consider diagnostic accuracy when deciding to withhold pain medication.     

Opioids: How to Improve Compliance and Adherence

Abstract: Chronic pain has been recognized as a major worldwide health care problem. Today, medical experts and health agencies agree that chronic pain should be treated with the same priority as the disease that caused it, and patients should receive adequate pain relief. To achieve good analgesia, patient adherence to a prescribed pain treatment is of high importance. Patients with chronic pain often do not use their medication as prescribed, but change the frequency of intake. This can result in poor treatment outcomes and may necessitate additional emergency treatment, which increases the overall costs. Factors that influence adherence include knowledge of the disease, realistic treatment expectations, perceived benefit from treatment, side effects, depression, dosing frequency, and attitudes of relatives/significant others toward opioids. Addressing all these factors should ensure a good treatment outcome. Good adherence to pain therapy is associated with improved efficacy in pain relief and quality of life. Opioids have become an integral part of the treatment of moderate to severe chronic noncancer pain. They may cause unpleasant side effects such as nausea, vomiting, and constipation. Patients should be informed adequately about side effects, which should be treated pro‐actively to foster adherence to treatment. Signs of tolerance, hyperalgesia, and drug abuse should be monitored as these may occur in some patients. An individualized treatment algorithm with a clear treatment goal and regular treatment reassessment is key for successful treatment. Long‐acting opioids offer sustained pain relief over 24 hours with manageable side effects—they simplify treatment thereby supporting treatment adherence.     

Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain

ContextWith increasing attention to the undertreatment of cancer pain in parallel with concerns about opioid misuse, little is known about how patients with advanced cancer adhere to opioid regimens for chronic cancer pain.ObjectivesWe explored patient approaches to managing chronic cancer pain with long-acting opioids.MethodsIn a multimethods study at an academic medical center, adult patients with chronic cancer pain (n = 17) used electronic pill caps to record adherence to prescribed long-acting opioid regimens. After eight weeks, patients viewed their adherence records and completed a semistructured interview about their opioid use. With a framework approach, we coded interview data (Kappa >0.95) and identified themes in how patients perceived and used opioids to manage cancer pain.ResultsPatients (59% female; 94% non-Hispanic white; median age = 65 years) felt grateful about pain benefit from opioids yet concerned about opioid side effects and addiction/tolerance. Main reasons for nonadherence included both intentional decisions (e.g., skipping doses) and unintentional barriers (e.g., missing doses due to inconsistent sleep schedules). Overall, patients set their own opioid adherence goals and developed routines to achieve them. Residual pain varied and was not consistently linked with opioid adherence.ConclusionPatients commonly felt conflicted about using prescribed long-acting opioids to manage cancer pain due to concurrent perceptions of their risks and benefits, and they set their own parameters for opioid-taking practices. Intentional and unintentional deviations from prescribed opioid schedules highlight the need to enhance adherence communication, education, and counseling, to optimize the use of long-acting opioids as a component of cancer pain management.     

Effect of mental health nurses' beliefs and knowledge of medication on their use of strategies to improve medication adherence

Despite the proven efficiency of medication for mental illness, research indicates low patient adherence to medication. Nonetheless, only few studies have directly examined the relationship between nurse beliefs and knowledge, and their use of strategies to improve patient adherence to psychiatric medication. Therefore, the aim of the present study was to clarify nurses' views, beliefs about, and knowledge of psychiatric medication affect their inclination to implement various strategies to improve patient adherence. One hundred nurses working at an Israeli psychiatric hospital participated in the study. Self‐completed questionnaires were distributed. The research findings showed that nurses' levels of knowledge of psychiatric medication were moderate, but their beliefs of taking psychiatric medication were positive. The findings also showed that the higher the nurses' age and seniority, as well as their positive beliefs about taking medication, the higher their probability of implementing strategies to improve patient adherence to medication. Additionally, there was a positive correlation between positive beliefs about the nursing staff on taking medication and the staff's utilization of strategies to improve patient adherence to medication. The current study shows that nurses' traits and beliefs affect their use of strategies promoting mental health patient adherence to medication and the enhancement of these strategies.     

Diabetic patients' medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments

OBJECTIVE—The purpose of this study was to determine how patients’ beliefs about antihyperglycemic and antihypertensive medications relate to medication underuse and health status.RESEARCH DESIGN AND METHODS—In diabetic patients from an economically distressed region, we assessed perceived necessity and harmfulness for antihyperglycemic (n = 803) and antihypertensive (n = 573) medications, past year''s medication underuse, A1C, systolic blood pressure (SBP), and diastolic blood pressure (DBP).RESULTS—After correction for multiple analyses, multivariate models indicated that perceived need for antihyperglycemic medication was associated with being younger, being prescribed insulin, and being prescribed multiple medications. Concern about antihyperglycemic medications was associated with being younger, African American, dissatisfied with information received about medication, and of low health literacy. For antihypertensives, perceived necessity was associated with having numerous medical comorbidities and being dissatisfied with medication information; concern was associated with being younger, dissatisfied with information received about medication, and of low health literacy. Up to one-half of patients underused at least one of the types of medication; many of these patients attributed this underuse to cost. For both types of medications, concern was significantly associated with both cost-related and non–cost-related underuse, and antihypertensive concern was associated with higher SBP and DBP.CONCLUSIONS—Even after adjustment for economic factors, patients who are younger, African American, or of low health literacy are especially concerned about medication harmfulness, which is in turn associated with medication underuse and higher blood pressure. To enhance adherence and outcomes, interventions should address patients’ underlying concerns about potential adverse treatment effects and focus on both cultural factors and health literacy.Despite advances in pharmacotherapy and decades of intervention trials to improve diabetes self-management support, adherence to diabetes medication regimens remains suboptimal (1). However, adherence is an “overdetermined” behavior insofar as it is influenced by a diverse variety of demographic, psychosocial, and economic factors. In this study, we focus on one of the least studied of these factors, patients’ personal beliefs about their treatment, because this construct seems to be an adherence determinant in other illnesses and is potentially modifiable through educational and psychosocial interventions.On both conceptual and empirical bases, treatment beliefs can be subdivided into adherence-increasing beliefs about treatment necessity and advantages and adherence-reducing beliefs about treatment harmfulness, risks, and barriers. Various forms of these constructs seem to explain adherence variation across several prevalent chronic illnesses, including HIV infection (2), depressive disorder (3–5), and cardiovascular disease (6). Although beliefs also appear to play a role in diabetes adherence, this conclusion is based mainly on single items from scales designed to measure other constructs and other nonstandardized measures (7,8).The nature, intensity, and impact of medication beliefs may vary across sociodemographic subgroups. For example, lower-income patients may be more fatalistic about their likelihood of negative illness outcomes and, as a consequence, be less motivated to pursue aggressive management or “tight control” regimens (9–12). Researchers and clinicians are also increasingly concerned about variation in health care trust, perceived discrimination, and outcomes between African American and Caucasian patients (7). Potential variations in diabetes treatment perceptions may provide an important window into these disparities.In this current study, we examined diabetic patients’ beliefs about their medication necessity and potential harmfulness in an economically distressed community. Given the importance of hypertension management for diabetes care, we also studied diabetic patients’ beliefs about their antihypertensive medications if applicable. After analyzing covariation in beliefs and sociodemographic characteristics, we modeled multivariate associations among beliefs, nonadherence (due to either cost or other reasons), and key medical outcomes.     

Accessing health care professionals about antipsychotic medication related concerns

The purpose of this research was to describe mental health service users' access to and satisfaction with health care professionals, including nurses, as related to users' antipsychotic medication concerns. Eighty-one service users were interviewed using a questionnaire. Participants stated that case managers were the most accessible, while psychiatrists were the least accessible. It was perceived that most professionals, apart from general practitioners, had adequate knowledge of medications. Most participants were satisfied with the way health care professionals dealt with the service users' concerns about medications, but almost 16% were dissatisfied with general practitioners. The findings emphasize that access to and satisfaction with health care professionals is an important factor in medication adherence.     

慢性心力衰竭患者服药依从性研究

目的 调查慢性心力衰竭患者的服药依从状况,并探讨其影响因素.方法 采用一般资料问卷、心力衰竭知识问卷、服药相关信念问卷、坚持服药的信心评分表及服药依从性问卷对200例住院和急诊留观的慢性心力衰竭患者进行调查,并采用多元有序Ordinal回归对患者服药依从性的影响因素进行分析.结果 患者服药依从性差,完全依从的仅有40....     

Cross national comparison of medical students’ attitudes and beliefs about medical cannabis and its application for pain management

ObjectivesTo examine attitudes and beliefs about medical cannabis (MC), and specifically about its application for pain management, across medical students in Israel and Thailand.DesignCross-sectional survey which measured attitudes and beliefs about MC. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain (arthritis, chronic pain, fibromyalgia and multiple sclerosis). Pearson's Chi-squared test was used to compare between students from the participating universities.Results430 medical students participated, 37.9 % (n = 163) from Israel and 62.1 % (n = 267) from Thailand. Personal cannabis use was reported by 55.6 % of the Israeli and only by 6.9 % of the Thai students (p < .001). Israeli secular students, compared to those from Thailand, were more likely to recommend MC for patient treatment, less concerned about serious physical and mental health risks, and more inclined to support legalization of recreational cannabis. Israeli students reported more permissive attitudes toward MC, but reported feeling less prepared to answer patient/client questions about MC than their Thai counterparts.ConclusionsThe findings of this study accentuate the need for curriculum designed around MC use to promote students' preparedness to serve patients in pain or with other medical conditions that may benefit from MC use.     

Beliefs about antidepressant medications in primary care patients: relationship to self-reported adherence

BACKGROUND: Adherence to medication is unacceptably low in both medical and psychiatric disorders. Explanatory models of illness beliefs and behaviors suggest that an individual's beliefs about a disorder and its treatment will influence their adherence. Given that beliefs about medications may influence adherence to antidepressants, we examined beliefs about medications in relation to antidepressant adherence in a primary care sample. OBJECTIVE: The purpose of this report is to 1) describe beliefs about medication in primary care patients prescribed antidepressants for depression; 2) examine the factor structure of the Beliefs about Medicines Questionnaire (BMQ) and compare it with the previously reported factor structure of the BMQ in medical conditions; and 3) examine the association of medication beliefs with self-reported medication adherence. RESULTS: Factor analysis indicates that the BMQ is valid in a sample of primary care patients receiving treatment for depression and has a similar factor structure to that obtained in samples of patients with chronic medical conditions. Beliefs about medications are significantly associated with self-reported adherence. Severity of depressive symptoms and specific concerns about antidepressants are significantly associated with self-reported medication-taking behavior. Findings suggest that in addition to telling patients how to take their medications, primary care physicians should also educate patients about the short- and long-term effects of the medication, how the medication works, and that antidepressants are not addictive.     

Pediatric Psychotropic Medication Initiation and Adherence: A Literature Review Based on Social Exchange Theory

TOPIC: Psychotropic medication initiation and adherence is an identified problem. This literature review explores factors that determine families' decisions to initiate, sustain, or discontinue use of psychotropic medication in children and adolescents. Social exchange theory is used as a framework to explore decisions to initiate and adhere to psychotropic medications. PURPOSE: Contributing factors related to psychotropic medication initiation, adherence, and discontinuation are explored. Themes in the literature encompassing costs and benefits of psychotropic medication adherence include family experiences with adverse effects, previous psychotropic medication experience, medication psychoeducation, stigma, societal views about psychotropic medication, particular diagnosis, the effect of comorbid diagnosis on adherence, attitudes and beliefs about medication by both children and parents, and relationships with the provider. The impact of family demographics including parent gender, age of the child, ethnicity, and parent educational level on psychotropic medication adherence is evaluated. SOURCES: International and U.S. studies from Medline, Cumulative Index for Nursing and Allied Health Literature and PsychInfo evaluating medication initiation and adherence in the pediatric psychiatric population and social exchange theory was incorporated from relevant textbook resources. CONCLUSIONS: Rewards experienced from medication treatment include improvement in symptoms, school performance and family relationships, and reduced level of parenting stress. Identified costs include impact of adverse side effects, social stigma, lack of response, fears of addiction, and changing the child's personality. Acceptance of the diagnosis influences adherence while medication education has varying effects. Families' attitudes, beliefs and perceptions about psychiatric illness and treatment play a large role in medication treatment decisions. A trusting provider relationship has a positive effect on adherence. Psychosocial treatment alternatives are preferred. With maturation, adolescents have more influence on decisions related to adherence.     

A qualitative study of medication adherence amongst people with schizophrenia

Non-adherence to antipsychotic medication is common among people with schizophrenia, and is associated with an increased risk of relapse. It is important to develop strategies to enhance medication adherence. Few qualitative studies have been undertaken to understand the consumer's perspective. The voice of people who are prescribed these medications is therefore missing from the research literature. Reasons for non-adherence were investigated by directly engaging with consumers and exploring their attitudes, beliefs and experiences concerning antipsychotic medications. Qualitative, semi- structured, one-to-one interviews were conducted with 25 community-dwelling people with schizophrenia from metropolitan Adelaide, Australia. Interviews were audio-recorded, transcribed and analysed, guided by a grounded theory approach. Codes identified in open coding were grouped into categories, reflective of the different aspects of consumers' attitudes and experiences with medication. Interviews continued until there was saturation of themes. Consumer-related factors, medication-related factors and service-related factors were reported to influence adherence behavior. These included poor insight, unpleasant medication side effects, inadequate efficacy and poor therapeutic alliance. Lessons gained during periods of non-adherence were the motivator for future adherence; such as worsening of symptoms if medication was not taken. Potential implications of future adherence described by Interviewees include greater involvement of peer workers, as they were considered to work more effectively with consumers to encourage adherence. Peer workers had more credibility than other service providers due to their lived experience. Multiple factors were identified that impact on antipsychotic medication adherence, providing opportunities for interventions and improvements in services that would enhance adherence.