title: Development of a Patient-Centered Antipsychotic Medication Adherence Intervention.
abstract: OBJECTIVE
  A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to develop an intervention to bridge this gap with the goal of improving antipsychotic medication adherence.
  
  
  METHODS
  IM is a stepwise method for developing and implementing health interventions. A previous study conducted in-depth qualitative interviews with patients diagnosed with schizophrenia and identified 477 BFMs associated with antipsychotic medication adherence. This article reports the results of using a variety of qualitative and quantitative item reduction and intervention development methods to transform the qualitative BFM data into a viable checklist and intervention.
  
  
  RESULTS
  The final BFM checklist included 76 items (28 barriers, 30 facilitators, and 18 motivators). An electronic and hard copy of the adherence progress note included a summary of current adherence, top three patient-identified barriers and top three facilitators and motivators, clarifying questions, and actionable adherence tips to address barriers during a typical clinical encounter.
  
  
  CONCLUSIONS
  The IM approach supplemented with qualitative and quantitative methods provided a useful framework for developing a practical and potentially sustainable antipsychotic medication adherence intervention. A similar approach to intervention development may be useful in other clinical situations where a substantial gap exists between patients and providers regarding medication adherence or other health behaviors.
authors.affiliation: Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA jmpyne@uams.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Ellen P
authors.initials: EP
authors.lastname: Fischer
authors.affiliation: South Central Mental Illness Research, Education and Clinical Centers, North Little Rock, AR USA.
authors.forename: LaNissa
authors.initials: L
authors.lastname: Gilmore
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Jean C
authors.initials: JC
authors.lastname: McSweeney
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Stewart
authors.affiliation: South Central Mental Illness Research, Education and Clinical Centers, North Little Rock, AR USA.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mittal
authors.affiliation: Booz Allen Hamilton Family Center, McLean, VA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Bost
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage*; D057189:Checklist; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D020380:Needs Assessment; D018802:Patient-Centered Care / Q000458:organization & administration*; D016730:Program Development; D015203:Reproducibility of Results
chemical_list: D014150:Antipsychotic Agents
keywords: intervention studies; medication adherence; qualitative research; schizophrenia